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Hypertension in pregnancy Flashcards

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1
Q

hypertension affects how many pregnancies

A

10-15%

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2
Q

what happens to blood pressure in early pregnancy

A

falls

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3
Q

what happens after the fall in BP

A

slowly rises until term after 22-23 weeks

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4
Q

what happens to BP after delivery

A

falls after
rises and peaks at day 3-4
can rise again till day 10 and then will usually return to pre pregnancy levels

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5
Q

hypertension values

A

> =140/90 on two occasions

DBP>110

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6
Q

pre existing hypertension when is it likely

A

if hypertension during early pregnancy as blood pressure should fall during this period

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7
Q

when will it be pre existing hypertension after delivery

A

if still present 3 months after delivery

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8
Q

what secondary causes should be considered when hypertension is present

A 
renal - do renal US
cardiac - echo
cushings
conns
phaemochromocytoma  TFTs
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9
Q 
PIH when dx
when does it resolve
signs
progression 
recurrence
A 
second half of the preg
6 weeks of delivery
no proteinuria or other signs of PET
15% progress to PET esp in early gestation
rate of recurrence is high
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10
Q

three common signs in PET

A

htn
proteinuria >=0.3/l or >= 0.3/24hours
oedema

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11
Q

what is PET

A

pregnancy specific multi system disorder with unpredictable variable end widespread manifestations

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12
Q

what are the different systems PET can affect

A 
renal
hepatic
cardiovascular 
haem
CNS
placenta
pulmonary
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13
Q

causes for PET

A

genetic usually

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14
Q

stages of PET

A

STAGE 1 abnormal placental perfusion in early pregnancy

STAGE 2 maternal syndrome

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15
Q

what is the pathogenesis for placentation

A

takes place in the first 20 weeks pf pregnancy
trophpblast invasion on the walls of the spinal artery which takes away the muscle layer around the artery going towards the decidua
this causes the spinal arteries to dilate and increases the blood flow to the placenta

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16
Q

what happens in PET associate with placentation

A

failure of trophoblastic invasion leading to low capacity high resistant circulation of blood
less blood goes to the placenta so the mother increases her blood pressure to try and compensate
this leads to endometrial damage leading to placental infarction causing further endometrial damage - in the second half of pregnancy this is manifested as PET

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17
Q

CNS disease in PET

A 
eclampsia
hypertensive encephalopathy - confusion
intracranial haemorrhage 
cerebral oedema 
corticol blindeness - occipital ischemia 
cranial nerve palsy 
in extreme forms can lead to a seizure
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18
Q

renal disease in PET

A 
decrease GFR
proteinuria
increased serum acid (also can be due to placental iscaemia)
increased creatinine/k/urea
oliguria/anuria
acute renal failure
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19
Q

urate level above what is always abnormal for a pregnancy woman

A

0.4

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20
Q

liver disease in PET

A

epigastric/RUQ pain
abnormal liver enzymes
hepatic capsule rupture

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21
Q

what is HELLP syndrome

what does it have

A

variant of eclampsia

haemolysis
elevated liver enzymes
low
platelets

high morbidity/mortality

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22
Q

haematological disease in PET

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A 
decrease in plasma volume
ahem concentration 
thrombocytopenia
haemolysis
disseminated intravascular coagulation
23
Q

cardiac/pulmonary disease in PET

Study These Flashcards
A

pulmonary oedema leads to ARDS which is usually iatrogenic due to fluid intake

PE - leading cause of maternal mortality

24
Q

placental disease in PET

Study These Flashcards
A

IUGR
placental abruption

both can potentially lead to intra uterine death

25
symptoms in PET
``` headache - CNS visual disturbance - CNS epigastric/RUQ pain - liver N/V - liver rapidly progressing oedema ```
26
signs in PET
``` htn proteinuria oedema abdominal tenderness/uterine tenderness disorientation due to encephalopathy SGA intra uterine death hyper flexia/involuntary movements/clonus ```
27
investigations in PET
``` U&Es serum urate LFTs FBC coag screen urinary protein creat ratio CTG US - biometry, AFI, doppler ```
28
management of PET
assess risk at booking if htn present <20 weeks look for secondary cause at antenatal screening - BP, urine, maternal uterine artery doppler treat hypertension maternal and fetal surveillance
29
risk factors for PET
``` maternal age >40 doubles risk maternal BMI >30 doubles risk FH 20-25% if mum affected 40% if sister first preg 2-3x risk multiple pregnancy 2x risk previous PET 7x risk molar pregnancy/triploidy ```
30
when is PET worse
when it is in the consecutive pregnancies and the first preg was fine - tends to be more severe
31
medical risk factors for PET
``` renal disease hypertension DM CTD - esp anti phospho synd thrombophillia ```
32
maternal uterine artery doppler when is it done | what does it assess and abnormalities
20-24 weeks with the fetal anomaly scan normal result is high resistance vessels going to low resistance vessels abnormal - high resistance - notch present
33
when should a px be referred to antenatal day care unit | how many of these women will be admitted
BP >=140-90 proteinuria ++ oedema present symptoms such as persistent headache for 1000 20
34
when should a px be admitted
BP >170/110 or >140/90 with proteinuria ++ significant symptoms - headache, visual disturbance, abdominal pain abnormal biochem significant proteinuria UPCR >30 need for anti hypertensives signs of fetal compromise
35
inpatient assessment - what is done
``` blood pressure - 4 hourly urinalysis - daily input/output fluid chart UPCR if proteinuria on urinalysis bloods - FBC, UandEs, LFTs min twice weekly ```
36
fetal surveillance
fetal movements CTG done daily US if no result on CTG - amniotic, biometry, umbilical artery doppler
37
umbilical artery doppler
can be used for someone who already has PET or IUGR | blood sent to the mum from the baby
38
treatment of hypertension when
>=150/100 | BP >=170/110 requires immediate treatment
39
wat can happen with MAP >=150
significant risk of cerebral haemorrhage
40
aim in BP
140-150/90-100
41
1st line in treatment of ht 2nd line 3rd line
labetalol nifedipine hydrazine IV for women with asthma who can't tolerate nifedipine
42
what should be given before delivering the baby
steroids - 12mg of dexa IM given at 4 or 12 hour intervals
43
indications for delivery
``` term gestations inability to control BP rapidly deteriorating biochem/haemo PET other crisis fetal crisis - REDF, abnormal CTG ```
44
crises in PET
``` eclampsia HELLP pulmonary oedema placental abruption cerebral haemorrhage corticol blindeness DIC acute renal failure hepatic failure ```
45
what do steroids do
promote fetal lung surfactant production | decrease neonatal respiratory distress syndrome by up to 50% if administered 24-48 hours before delivery
46
eclampsia seizure
tonic clonic occurs before features of PET >1/3 will have one before the onset of htn/proteinuria most common in teenagers assoc with ischaemia/cerebral vasopasm
47
when do most seizures occur
in labour or after
48
management of severe PET/ecmlapsia
control BP - IV labetalol, IV hydralazine stop/prevent seizures fluid balance delivery
49
seizure management/prophylaxis
Mg sulphate 4g IV over 5 mins maintenance dose IV infusion 1g/h if further seizures then 2mg mg sulphate if persistent then diazepam 10mg IV
50
how much fluid an hour
80ml
51
treatment of oliguria following delivery
does not require intervention common happens to 30% of women
52
what should be avoided in labour
ergometrine as it causes maternal hypertension - just use syntocin
53
dose of aspirin given and why and to who
75mg prevents PET given to anyone with risk factors for PET

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