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Hypertension in Pregnancy Flashcards

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1
Q

What is the most common cause of iatrogenic prematurity?

A

Pre-eclampsia

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2
Q

Does pregnancy cause vasodilatation or vasoconstriction?

A

Vasoconstriction

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3
Q

What happens to blood pressure in early pregnancy?

A

Falls

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4
Q

When is nadir reached?

A

22-24 weeks

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5
Q

What is nadir?

A

Lowest point of deccelaration

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6
Q

When does BP rise and fall after nadir?

A

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

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7
Q

What is the diagnosis of hypertension?

A

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

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8
Q

What are possible secondary causes of hypertension?

A

Renal
Cardiac
Cushing’s/Conns/Phaeochromocytoma

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9
Q

When does pregnancy induced hypertension (PIH) occur?

A

2nd half of pregnancy

Resolves 6 weeks after delivery

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10
Q

What are the features of pre-eclampsia?

A

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

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11
Q

What happens in pre-eclampsia?`

A

Diffuse vascular endothelial widespread circulatory disturbance

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12
Q

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

A

Stage 1 - Abnormal placental perfusion

Stage 2 - Maternal syndrome

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13
Q

What generally happens in pre-eclampsia?

A

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

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14
Q

What endothelial activation happens in pre-eclampsia?

A 
Increased capillary permeability
Increased expression of CAM
Increased prothrombotic factors
Increased platelet aggregration
Vasoconstriction
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15
Q

What other bodily systems does pre-eclampsia effect?

A 
CNS
Renal
Hepatic
Haematological
Pulmonary
Cardiovascular 
Placental
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16
Q

What CNS diseases can pre-eclampsia lead to?

A 
Eclampsia
Hypertensive encephalopathy
Intracranial haemorrhage
Cerebral haemorrhage
Cortical blindness
Cranial nerve palsy
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17
Q

What renal disease can pre-eclampsia cause?

A

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

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18
Q

What liver diseases can pre-eclampsia?

A 
Epigastric/RUQ pain
Abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome
(Haemolysis, Elevated liver enzymes, Low platelets) - high morbidity/mortality
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19
Q

What haematological diseases can be caused by pre-eclampsia?

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A 
Decreased plasma volume
Haemo-concentration
Thrombocytopenia
haemolysis
Disseminated intravascular coagulation
20
Q

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

Study These Flashcards
A

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

21
Q

What placental disorders can pre-eclampsia cause?

Study These Flashcards
A

Intrauterine growth restriction (IUGR)
Placental abruption
Intrauterine death

22
Q

What symptoms are assoc. with pre-eclampsia?

Study These Flashcards
A 
Headache
Visual disturbance
Epigastric/RUQ pain
Nausea/Vomiting
Rapidly progressive oedema
23
Q

What are signs assoc. with pre-eclampsia?

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A 
Hypertension
Proteinuria
Oedema
Abdominal tenderness
Disorientation
SGA
IUD
Hyper-reflexia 
Involuntary movements
Clonus
24
Q

What investigations should be done for suspected pre-eclampsia?

Study These Flashcards
A 
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
31
When should you deliver?
Mother must firstly be stabilised Consider management if pre-term Most women deliver within 2 weeks of diagnosis
32
What are indications for delivery?
``` Term gestation Inability to control BP Rapidly deteriorating biochemistry/haematology Eclampsia Other crisis Fetal compromise - REDF, abnormal CTG ```
33
What are crises in pre-eclampsia?
``` Eclampsia HELLP syndrome Pulmonary oedema Placental abruption Cerebral haemorrhage Cortical blindness DIC Acute renal failure Hepatic rupture ```
34
What benefit do the steroids have towards the fetus?
Promote fetal lung surfactant production | Reduces neonatal respiratory distress syndrome by up to 50%
35
When should steroids be administered?
24-48hrs before delivery
36
When can be steroids be administered by?
36 weeks gestation
37
What steroid is preferred?
betamethasone (2X 12mg injections 12hrs apart)
38
What happens in eclampsia?
Tonic-clonic (grand mal) seizure occuring with pre-eclampsia features
39
What is eclampsia assoc. with?
Ischaemia | Vasospasm
40
What is the management of severe PET / eclampsia?
Control BP Stop/prevent seizures Fluid balance Delivery
41
What 2 antihypertensives are used on pregnant women?
IV Labetalol | IV Hydralazine
42
What is used as seizure treatment/prophylaxis?
magnesium sulphate
43
What doses of magnesium sulphate?
Loading dose - 4g IV over 5 mins | Maintenance dose - IV infusion 1g/h
44
If further seizures happen what dose of magnesium sulphate should be given?
2g
45
What should be given if seizures are persistent?
Diazepam 10mg IV
46
What drug may be beneficial in preventing severe early onset pre-eclampsia?
Aspirin
47
When should aspirin be started?
Before 12 weeks

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