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Flashcards in Hypertension in Pregnancy Deck (47)
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1

What is the most common cause of iatrogenic prematurity?

Pre-eclampsia

2

Does pregnancy cause vasodilatation or vasoconstriction?

Vasoconstriction

3

What happens to blood pressure in early pregnancy?

Falls

4

When is nadir reached?

22-24 weeks

5

What is nadir?

Lowest point of deccelaration

6

When does BP rise and fall after nadir?

Steady rise until term
Fall after delivery
Rise at day 3/4 post-natal

7

What is the diagnosis of hypertension?

>_140/90 mmHg on 2 occasions
DBP >110mmHg
ACOG - >30/15mmHg compared to booking BP

8

What are possible secondary causes of hypertension?

Renal
Cardiac
Cushing's/Conns/Phaeochromocytoma

9

When does pregnancy induced hypertension (PIH) occur?

2nd half of pregnancy
Resolves 6 weeks after delivery

10

What are the features of pre-eclampsia?

Hypertension
Proteinuria (>_0.3g/l or >_0.3g/24hours)
Oedema

11

What happens in pre-eclampsia?`

Diffuse vascular endothelial widespread circulatory disturbance

12

What happens in stage 1 and stage 2 of pre-eclampsia?

Stage 1 - Abnormal placental perfusion
Stage 2 - Maternal syndrome

13

What generally happens in pre-eclampsia?

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

14

What endothelial activation happens in pre-eclampsia?

Increased capillary permeability
Increased expression of CAM
Increased prothrombotic factors
Increased platelet aggregration
Vasoconstriction

15

What other bodily systems does pre-eclampsia effect?

CNS
Renal
Hepatic
Haematological
Pulmonary
Cardiovascular
Placental

16

What CNS diseases can pre-eclampsia lead to?

Eclampsia
Hypertensive encephalopathy
Intracranial haemorrhage
Cerebral haemorrhage
Cortical blindness
Cranial nerve palsy

17

What renal disease can pre-eclampsia cause?

Decreased GFR
Proteinuria
Increased serum uric acid (also placental ischaemia)
Increased creatinine/Potassium/Urea
Oliguria/Anuria
Acute renal failure - acute tubular necrosis, renal cortical necrosis

18

What liver diseases can pre-eclampsia?

Epigastric/RUQ pain
Abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome
(Haemolysis, Elevated liver enzymes, Low platelets) - high morbidity/mortality

19

What haematological diseases can be caused by pre-eclampsia?

Decreased plasma volume
Haemo-concentration
Thrombocytopenia
haemolysis
Disseminated intravascular coagulation

20

What cardiac/pulmonary diseases can be caused by pre-eclampsia?

Pulmonary oedema --> ARDS - iatrogenic, disorder related
Pulmonary embolus
High mortality

21

What placental disorders can pre-eclampsia cause?

Intrauterine growth restriction (IUGR)
Placental abruption
Intrauterine death

22

What symptoms are assoc. with pre-eclampsia?

Headache
Visual disturbance
Epigastric/RUQ pain
Nausea/Vomiting
Rapidly progressive oedema

23

What are signs assoc. with pre-eclampsia?

Hypertension
Proteinuria
Oedema
Abdominal tenderness
Disorientation
SGA
IUD
Hyper-reflexia
Involuntary movements
Clonus

24

What investigations should be done for suspected pre-eclampsia?

Urea & electrolytes
Serum urate
Liver function tests
Full blood count
Coagulation screen
UPCR
CTG
Ultrasound - biometry, AFI, Doppler

25

What's the management of pre-eclampsia?

Assess risk at booking
Hypertension <20 wks = look for secondary cause
Antinatal screening - BP, urine, MUAD
Treat hypertension
Maternal & fetal surveillance
Timing of delivery
PIH can be managed as O/P in day care unit

26

What are risk factors for pre-eclampsia?

Maternal age - >40 years
maternal BMI - >30
FHx
Parity (1st pregnancy)
Multiple pregnancy
Previous PET
Molar pregnancy/Triploidy

27

What are medical risk factors for pre-eclampsia?

Pre-existing renal disease
Pre-existing hypertension
Diabetes mellitus
Connective tissue disease
Thrombophilias (congenital/acquired)

28

What 6 reasons would make you admit someone with suspected pre-eclampsia?

1. BP >170/110 or >140/90 + proteinuria
2. Significant symptoms - headache / visual disturbances/ abdominal pain
3. Abnormal biochemistry
4. Significant proteinuria
5. Need for antihypertensive therapy
6. Signs of fetal compromise

29

How do you assess an inpatient?

Blood pressure - 4 hourly
Urinalysis - daily
Input/Output fluid balance chart
UPCR - proteinuria on urinalysis
Bloods - FBC, U&E's, Urate, LFT's, minimum X2 per week

30

How is fetal surveillance carried out?

Fetal movements
CTG - daily
Ultrasound - Biometry, amniotic fluid index, umbilical artery doppler