Flashcards in Hypertension in Pregnancy Deck (39):
What is the incidence of HT in pregnancy?
What is the commonest cause of iatrogenic prematurity?
Describe BP throughout pregnancy
Falls in early pregnancy
Nadir reached at 22-24wks
Steady rise until term
Falls after delivery but rises and peaks at day 3-4 P/N
What are the risks associated with pre-existing HT?
When will PIH occur and resolve?
Second half of pregnancy
Resolves within 6/52 PN
What are they key features of pre-eclampsia?
Proteinuria (>=0.3g/l or >=0.3g/24hrs)
What are some of the pathophysiological causes of pre-eclampsia?
Abnormal placentation and trophoblast invasion, leading to failure of normal vascular remodelling
Spiral arteries fail adapt to become high capacitance, low resistance vessels
Placental ischaemia, leading to widespread endothelial damage and dysfunction
Endothelial activation leading to increased capillary permeability, expression of CAM, prothrombotic factors, platelet aggregation and vasoconstriction
What are the CNS components of pre-eclampsia?
Cranial Nerve Palsy
What are the renal components of pre-eclampsia?
Increased serum uric acid (also placental ischaemia) and creatinine/potassium/urea
Acute renal failure- acute tubular necrosis, renal cortical necrosis
What are the hepatic components of pre-eclampsia?
Abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome: Haemolysis, Elevated Liver Enzymes, Low Platelets-high morbidity/mortality
What are the haematological components of pre-eclampsia?
Disseminated Intravascular Coagulation
What are the cardiopulmonary components of pre-eclampsia?
Pulmonary oedema leading to ARDS- iatrogenic, disorder related
What are the placental components of pre-eclampsia?
What are the symptoms of pre-eclampsia?
Rapidly progressive oedema
What are the signs of pre-eclampsia?
Hyper-reflexia / involuntary movements / clonus
What Ix are required in pre-eclampsia?
Urea & Electrolytes
Liver Function Tests
Full Blood Count
Ultrasound - biometry, AFI, Doppler
How is pre-eclampsia managed?
Assess risk at booking
HT at <20wks-look for 2' cause
Antenatal screening- BP, urine, MUAD
Maternal & fetal surveillance
Timing of delivery
PIH can be managed as OP in Day Care Unit
What are the RFs for pre-eclampsia?
Maternal age (>40y: 2x)
Maternal BMI (>30: 3x)
FHx (20-25% if mother affected, up to 40% if sister)
Parity (1st pregnancy 2-3x)
Multiple pregnancy (Twins 2x)
Previous PET (7x)
What are the medical RFs for pre-eclampsia?
Pre-existing renal disease
When should you refer to AN DCU?
Symptoms: esp persistent headache
When should you admit women with pre-eclampsia?
BP >170/110 OR >140/90 with (++) proteinuria
Significant symptoms - headache / visual disturbance / abdominal pain
Significant proteinuria - UPCR >30mg/mmol
Need for antihypertensive therapy
Signs of fetal compromise
How should HT be treated in pregnancy?
Treat regardless of cause
With MAP of >=150mmHg significant risk of cerebral haemorrhage
BP >=170/110 requires immediate Rx
Aim for 140-150/90-100
When is methyl dopa contraindicated in HT treatment?
When is labetolol contraindicated in HT treatment?
Are methyl dopa, labetolol, nifedipine SR and hydralazine safe in pregnancy?
When are most deliveries carried out after a pre-eclampsia diagnosis?
Within 2 wks of diagnosis
What are the indications for delivery in pregnancy with HT?
Inability to control BP
Rapidly deteriorating biochemistry / haematology
Fetal Compromise - REDF, abnormal CTG
What are some crises in pre-eclampsia?
Acute Renal Failure
What is eclampsia?
Tonic-clonic (grand mal) seizure occurring with features of pre-eclampsia
How many women will have eclampsia seizure before onset of proteinuria/HT?
In what age group is eclampsia more common?
What antihypertensives are used in eclampsia?
(beware hypotension-fetoplacental unit)
What is the treatment and prophylaxis for eclampsia seizure?
Loading dose 4g IV over 5mins
Maintenance IV infusion 1g/h
If further seizurs 2g MgSO4
If persistent consider diazepam 10mg IV
What is the main cause of death in eclampsia?
What is the safe option in fluid administration in eclampsic patients?
Run patient dry- 80ml/hr
Fluid challenges can be dangerous
What should be checked when there is any doubt about renal function in an eclampsic patient?
Does oliguria require intervention in eclampsia?
No- occurs in 30%
Describe labour and delivery in eclampsia
Aim for vaginal delivery if possible
Continuous electronic fetal monitoring
Caution with iv fluids