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Flashcards in Hypertension in pregnancy Deck (53):
1

hypertension affects how many pregnancies

10-15%

2

what happens to blood pressure in early pregnancy

falls

3

what happens after the fall in BP

slowly rises until term after 22-23 weeks

4

what happens to BP after delivery

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

5

hypertension values

>=140/90 on two occasions
DBP>110

6

pre existing hypertension when is it likely

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

7

when will it be pre existing hypertension after delivery

if still present 3 months after delivery

8

what secondary causes should be considered when hypertension is present

renal - do renal US
cardiac - echo
cushings
conns
phaemochromocytoma TFTs

9

PIH when dx
when does it resolve
signs
progression
recurrence

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

10

three common signs in PET

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

11

what is PET

pregnancy specific multi system disorder with unpredictable variable end widespread manifestations

12

what are the different systems PET can affect

renal
hepatic
cardiovascular
haem
CNS
placenta
pulmonary

13

causes for PET

genetic usually

14

stages of PET

STAGE 1 abnormal placental perfusion in early pregnancy

STAGE 2 maternal syndrome

15

what is the pathogenesis for placentation

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

16

what happens in PET associate with placentation

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

17

CNS disease in PET

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

18

renal disease in PET

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

19

urate level above what is always abnormal for a pregnancy woman

0.4

20

liver disease in PET

epigastric/RUQ pain
abnormal liver enzymes
hepatic capsule rupture

21

what is HELLP syndrome
what does it have

variant of eclampsia

haemolysis
elevated liver enzymes
low
platelets

high morbidity/mortality

22

haematological disease in PET

decrease in plasma volume
ahem concentration
thrombocytopenia
haemolysis
disseminated intravascular coagulation

23

cardiac/pulmonary disease in PET

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

PE - leading cause of maternal mortality

24

placental disease in PET

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