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Hypertension in Pregnancy Flashcards

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1
Q

How common is eclampsia

A

1/2000 pregnancies affected

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2
Q

What happens to the blood vessels in pregnancy

A

vasodilation

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3
Q

What happens to the BP in early pregnancy

A

falls with lowest point at 22-24 wks

slowly rises until term

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4
Q

What happens to BP after delivery

A

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

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5
Q

How is hypertension diagnosed in pregnancy

A

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

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6
Q

what are the three categories of hypertension in pregnancy

A 
pre existing (first half)
pregnancy induced (second half)
pre eclampsia (usually ins econd half)
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7
Q

What are the possible risks of hypertension in pregnancy

A

PET
IUGR
Abruption

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8
Q

What are the features of PIH

A 
Second half of pregnancy
Resolves within 6 wks post partum
No proteinuria
Some progress to pre eclampsia
High recurrence rate
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9
Q

What are the defining features of pre eclampsia

A

Hypertension
Proteinuria
Oedema

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10
Q

What is the pathogenesis of pre eclampsia

A

Genetic predisposition

Two stages: abnormal placental perfusion and maternal syndrome

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11
Q

What medications can be used to treat hypertension in pregnancy

A
  1. Labetalol
  2. Methyldopa
  3. Nifedipine ( if monotherapy fails)
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12
Q

What hypertensive medications need to be stopped in pregnancy

A

ACE inhibitors and ARBs ‘sartans’

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13
Q

How is severe hypertension treated eg 165/110

A

Labetalol oral or IV
Hydralazine
Nifedipine

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14
Q

What is the target BP in pregnancy

A

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

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15
Q

When should the baby be delivered in pre eclampsia

A

37 weeks

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16
Q

Describe the pathogenesis of pre-eclampsia

A

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

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17
Q

What CNS problems can occur due to hypertension in pregnancy

A 
eclampsia
hypertensive encephalopathy
Intracranial haemorrhage
Cerebral oedema
cortical blindness
cranial nerve palsy
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18
Q

What renal disease may occur due to hypertension in pregnancy

A 
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
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19
Q

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

A

HELLP syndrome

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20
Q

What dies HELLP syndrome stand for

A

Haemolysis
Elevated Liver enzymes
Low Platelets

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21
Q

What haematological conditions can occur due to high BP

Study These Flashcards
A

decreased plasma volumeHaemo-concentration
Thrombocytopenia
Haemolysis
Disseminated Intravascular Coagulation

22
Q

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

Study These Flashcards
A

PE

Pulmonary oedema –> ARDS

23
Q

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

Study These Flashcards
A

IUGR due to placental insufficiency
Placental abruption
IUD

24
Q

What are the symptoms of pre eclampsia

Study These Flashcards
A 
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

Reproduction (52 decks)

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