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Flashcards in Hypertension in pregnancy Deck (47)
1

blood pressure is proportional t systemic vascular resistance and cardiac output

blood pressure falls in second trimester

2

when is nadir reached?

22-24 weeks

3

after nadir, what happens?

steady rise until term

4

after delivery what happens to blood pressure?

falls but then subsequently rises and peaks around day 3/4

5

hypertension. what does bp have to be over on 2 occasions?

140/90
DBP >110
or >30/15 compared to booking visit

6

what 2 factors makes HTN likey to be pre exising?

if its before 20 weeks gestation, or BP has not returned to normal within 3 months of delivery

7

pregnancy induced hypertension, how long does it take to resolve

6 weeks

8

15% of gestational hypertension go on to ?

pre eclampsia

9

3 things in pre eclampsia?

hypertension, proteinuria (>0.3g/l), oedema. lack of oedema doesn't exclude diagnosis

10

pre eclampsia risk factors?

1st child, obesity, history, diabetes, obesity, kidney disease

11

buz diffuse vascular endothelial dysfunction

pathogenesis - abnormal formation of placenta and trophoblast invasion. failure of vascular remodelling

12

2 stages of pre eclampsia?

stage 1 - abnormal placental perfusion
2 - maternal syndrome

13

pre eclampsia is a multi system disorder**** it affects...

CNS, renal, hepatic, haematological, cardio, placental

14

symptoms of pre eclampsia?

headache, visual disturbance, epigastric RUQ pain, nausea, vomiting, rapidly progressive oedema

15

3 main signs?

hypertension, proteinuria, oedema

16

risk factors?

family history, history, obesity, first child, over 40, obese, diabetes,CKD, connective tissue disease, thrombophilia

17

when to admit?

BP>170/110 or >140/190 with proteinuria

18

significant symptoms - headache visual disturbance, abdominal pain

abnoral biochemistry

19

proteinuria (jd)

need for antihypertensive therapy (gr)

20

signs of fetal compromise

Inpatient assessment - blood pressure 4 hourly, urinalysis,, input/output, UPCR, bloods - minimum 2 per week

21

with an MAP of over 150, there is a significant risk of cerebral haemorrhage

y

22

how do you calculate MAP?

2d + s / 3

23

control of blood pressure DOES NOT reduce the risk of pre eclampsia

.

24

what class of drug is nifedipine?

calcium channel blocker

25

labetalol?

alpha and beta blocker

26

who can you not give labetalol to?

asthmatic patients

27

methyl dopa - what class of drug?

alpha agonist

28

who can you not give metal dopa to?

patients with depression

29

hydralazine?

vasoconstrictor

30

what do steroids promote?

fetal lung surfactant production

31

steroids reduce RDS by 50% if administered 24-48 hours before delivery

can administer up to 36 weeks

32

what steroid would you use?

betamethasone

33

tonic clonic seizure occurring with features of pre eclampsia?

eclampsia

34

who is eclampsia more common in?

teenagers

35

management?

control blood pressure, stop seizures, fluid balance, delivery

36

what do you use to control blood pressure?

IV LOL HI IV labetalol, hydralazine

37

prophylaxis/seizure treatment?

magnesium sulphate

38

if persistent consider?

diazapam

39

main cause of death from pre eclampsia?

pulmonary oedema

40

what is used to prevent seizures in women with pre eclampsia?

magnesium sulphate

41

what does aspirin inhibit?

COX

42

what pathway is COX involved in?

production of TXA2

43

when would you commence aspirin treatment in a high risk patient?

before 12 weeks

44

placental ischaemia leads to widespread endothelial damage and dysfunction

.

45

what happens to spiral arteries?

fail to adapt to become high capacitance, low resistance vesslels.

46

lack of blood to placenta leads to

oxidative stress. PGI2:TXA2 imbalance.

47

get endothelial activation. increased permeability, expression CAM, prothrombotic factors, platelet aggregation, vasoconstriction

.