Flashcards in Hypertension in Pregnancy Deck (47):
What is the most common cause of iatrogenic prematurity?
Does pregnancy cause vasodilatation or vasoconstriction?
What happens to blood pressure in early pregnancy?
When is nadir reached?
What is nadir?
Lowest point of deccelaration
When does BP rise and fall after nadir?
Steady rise until term
Fall after delivery
Rise at day 3/4 post-natal
What is the diagnosis of hypertension?
>_140/90 mmHg on 2 occasions
ACOG - >30/15mmHg compared to booking BP
What are possible secondary causes of hypertension?
When does pregnancy induced hypertension (PIH) occur?
2nd half of pregnancy
Resolves 6 weeks after delivery
What are the features of pre-eclampsia?
Proteinuria (>_0.3g/l or >_0.3g/24hours)
What happens in pre-eclampsia?`
Diffuse vascular endothelial widespread circulatory disturbance
What happens in stage 1 and stage 2 of pre-eclampsia?
Stage 1 - Abnormal placental perfusion
Stage 2 - Maternal syndrome
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
What endothelial activation happens in pre-eclampsia?
Increased capillary permeability
Increased expression of CAM
Increased prothrombotic factors
Increased platelet aggregration
What other bodily systems does pre-eclampsia effect?
What CNS diseases can pre-eclampsia lead to?
Cranial nerve palsy
What renal disease can pre-eclampsia cause?
Increased serum uric acid (also placental ischaemia)
Acute renal failure - acute tubular necrosis, renal cortical necrosis
What liver diseases can pre-eclampsia?
Abnormal liver enzymes
Hepatic capsule rupture
(Haemolysis, Elevated liver enzymes, Low platelets) - high morbidity/mortality
What haematological diseases can be caused by pre-eclampsia?
Decreased plasma volume
Disseminated intravascular coagulation
What cardiac/pulmonary diseases can be caused by pre-eclampsia?
Pulmonary oedema --> ARDS - iatrogenic, disorder related
What placental disorders can pre-eclampsia cause?
Intrauterine growth restriction (IUGR)
What symptoms are assoc. with pre-eclampsia?
Rapidly progressive oedema
What are signs assoc. with pre-eclampsia?
What investigations should be done for suspected pre-eclampsia?
Urea & electrolytes
Liver function tests
Full blood count
Ultrasound - biometry, AFI, Doppler
What's the management of pre-eclampsia?
Assess risk at booking
Hypertension <20 wks = look for secondary cause
Antinatal screening - BP, urine, MUAD
Maternal & fetal surveillance
Timing of delivery
PIH can be managed as O/P in day care unit
What are risk factors for pre-eclampsia?
Maternal age - >40 years
maternal BMI - >30
Parity (1st pregnancy)
What are medical risk factors for pre-eclampsia?
Pre-existing renal disease
Connective tissue disease
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
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
How is fetal surveillance carried out?
CTG - daily
Ultrasound - Biometry, amniotic fluid index, umbilical artery doppler
When should you deliver?
Mother must firstly be stabilised
Consider management if pre-term
Most women deliver within 2 weeks of diagnosis
What are indications for delivery?
Inability to control BP
Rapidly deteriorating biochemistry/haematology
Fetal compromise - REDF, abnormal CTG
What are crises in pre-eclampsia?
Acute renal failure
What benefit do the steroids have towards the fetus?
Promote fetal lung surfactant production
Reduces neonatal respiratory distress syndrome by up to 50%
When should steroids be administered?
24-48hrs before delivery
When can be steroids be administered by?
36 weeks gestation
What steroid is preferred?
betamethasone (2X 12mg injections 12hrs apart)
What happens in eclampsia?
Tonic-clonic (grand mal) seizure occuring with pre-eclampsia features
What is eclampsia assoc. with?
What is the management of severe PET / eclampsia?
What 2 antihypertensives are used on pregnant women?
What is used as seizure treatment/prophylaxis?
What doses of magnesium sulphate?
Loading dose - 4g IV over 5 mins
Maintenance dose - IV infusion 1g/h
If further seizures happen what dose of magnesium sulphate should be given?
What should be given if seizures are persistent?
Diazepam 10mg IV
What drug may be beneficial in preventing severe early onset pre-eclampsia?