Hypertension in Pregnancy Flashcards Preview

Reproduction > Hypertension in Pregnancy > Flashcards

Flashcards in Hypertension in Pregnancy Deck (51)
1

How common is eclampsia

1/2000 pregnancies affected

2

What happens to the blood vessels in pregnancy

vasodilation

3

What happens to the BP in early pregnancy

falls with lowest point at 22-24 wks
slowly rises until term

4

What happens to BP after delivery

falls but subsequently rises and peaks at 3-4 days post natal

5

How is hypertension diagnosed in pregnancy

more than 140/90 on 2 occasions
DBP more than 110
according to ACOG - rise of more than 30/15 compared to booking BP = hypertension

6

what are the three categories of hypertension in pregnancy

pre existing (first half)
pregnancy induced (second half)
pre eclampsia (usually ins econd half)

7

What are the possible risks of hypertension in pregnancy

PET
IUGR
Abruption

8

What are the features of PIH

Second half of pregnancy
Resolves within 6 wks post partum
No proteinuria
Some progress to pre eclampsia
High recurrence rate

9

What are the defining features of pre eclampsia

Hypertension
Proteinuria
Oedema

10

What is the pathogenesis of pre eclampsia

Genetic predisposition
Two stages: abnormal placental perfusion and maternal syndrome

11

What medications can be used to treat hypertension in pregnancy

1. Labetalol
2. Methyldopa
3. Nifedipine ( if monotherapy fails)

12

What hypertensive medications need to be stopped in pregnancy

ACE inhibitors and ARBs 'sartans'

13

How is severe hypertension treated eg 165/110

Labetalol oral or IV
Hydralazine
Nifedipine

14

What is the target BP in pregnancy

Aim fro less than 150/80-100
If there is organ damage er proteinuria, aim for 140/90
less than 140/90 consider reducing dose
If less than 130/90 reduce dose

15

When should the baby be delivered in pre eclampsia

37 weeks

16

Describe the pathogenesis of pre-eclampsia

Abnormal placentation and trophoblast invasion --> failure of normal vascular remodelling
Spiral arteries fail to adapt to become high capacitance, low resistance vessels
Placental ischaemia --> widespread endothelial damage and dysfunction

17

What CNS problems can occur due to hypertension in pregnancy

eclampsia
hypertensive encephalopathy
Intracranial haemorrhage
Cerebral oedema
cortical blindness
cranial nerve palsy

18

What renal disease may occur due to hypertension in pregnancy

increased GFR
Proteinuria
increased serum uric acid (also placental ischaemia)
increased creatinine / potassium / urea
Oliguria /anuria
Acute renal failure
acute tubular necrosis
renal cortical necrosis

19

What lifethreatening liver disease can occur due to pre-eclampsia/ high BP in pregnancy

HELLP syndrome

20

What dies HELLP syndrome stand for

Haemolysis
Elevated Liver enzymes
Low Platelets

21

What haematological conditions can occur due to high BP

decreased plasma volumeHaemo-concentration
Thrombocytopenia
Haemolysis
Disseminated Intravascular Coagulation

22

What CVS/lung disease can occur due to high BP in pregnancy

PE
Pulmonary oedema --> ARDS

23

What else is there an increased risk of in pregnancies with hypertension

IUGR due to placental insufficiency
Placental abruption
IUD

24

What are the symptoms of pre eclampsia

Headache
Visual disturbance
Epigastric /RUQ pain
Nausea and vomiting
Oedema which is rapidly progressing

25

What signs may be present in pre eclampsia

Hypertension
Proteinuria
Oedema
Abdominal tenderness
Disorientation
Small for gestational age
IUD
Hyper-reflexia / involuntary movements / clonus

26

What are the risk factors for preeclampsia

Maternal Age (>40 years 2X)
Maternal BMI (>30 2X)
Family History (20-25% if mother affected, up to 40% if sister)
Parity (first pregnancy 2-3X)
Multiple pregnancy (Twins 2X)
Previous PET (7X)
Molar Pregnancy / Triploidy

Multiparous women develop more severe disease

27

What medical conditions make a woman more at risk of pre eclampsia

Pre-existing renal disease
Pre-existing hypertension
Diabetes Mellitus
Connective Tissue Disease
Thrombophilias (congenital / acquired

28

What test can be done to predict pre eclampsia and at what gestation

Maternal uterine artery Doppler
20-24 weeks

29

When would you admit a woman with pre eclampsia

BP >170/110 OR >140/90 with (++) proteinuria

Significant symptoms - headache / visual disturbance / abdominal pain

Abnormal biochemistry

Significant proteinuria - UPCR >30mg/mmol

Need for antihypertensive therapy

Signs of fetal compromise

30

How are in patients with pre eclampsia assessed

Blood Pressure - 4 hourly

Urinalysis - daily

Input / output fluid balance chart

UPCR - if proteinuria on urinalysis

Bloods - FBC, U&Es, Urate, LFTs. Minimum X2 per week

31

How is the fetus monitored in fetal surveillance

Fetal Movements

CTG - daily

Ultrasound
Biometry
Amniotic Fluid Index
Umbilical Artery Doppler

32

At what MAP is there a significant risk of cerebral haemorrhage

more than 150mmHg

33

When should you treat hypertension in pregnancy

if BP more than 150/100

34

How is MAP calculated

(2x diastolic + systolic) /3

35

What is the mechanism of action of methyldopa

centrally acting alpha agonists

36

Mechanism of action of labetalol

alpha and beta agonist

37

Mechanism of action of nifedipine

calcium channel antagonist

38

Mechanism of action of hydralzine

vasodilator

39

Contraindications of methyldopa

depression

40

contraindications of labetalol

asthma

41

What is the cure for pre eclampsia

deliver baby

42

What would be indications for delivery

Term gestation
Inability to control BP
Rapidly deteriorating biochemistry / haematology
Eclampsia
Other Crisis
Fetal Compromise - REDF, abnormal CTG

43

List crises in pre eclampsia

Eclampsia
HELLP syndrome
Pulmonary Oedema
Placental Abruption
Cerebral Haemorrhage
Cortical Blindness
DIC
Acute Renal Failure
Hepatic Rupture

44

What is eclampsia

Grand mall seizure with symptoms/features of pre eclampsia

45

when does most eclampsia occur

post partum

46

what age group is eclampsia more common in

teenagers

47

What are the four principles of managing severe PET/eclampsia

control bp
stop/prevent seizures
fluid balance
delivery

48

What is given for seizure treatment /prophylaxiz

magnesium sulphate 4g IV over five mins
maintain with IV infustion 1g/h
if further seizures admister 2g Mg sulphate
If persistant consider diazepam,

49

what is the main cause of death in pre eclampsia

pulmonary oedema

50

What should be given with caution in pts with preeclampsia or eclampsua

IV fluids - safer to run patient dry

51

When is low dose aspirin given

high risk women (previous PET etc)
best at preventing severe early onset pre eclampsia
commence before 12 weeks