Hypertension in Pregnancy Flashcards
(34 cards)
what happens to blood pressure in pregnancy
falls in early pregnancy
reaches plateau at 22-24 weeks
Rises until term
what happens to BP after delivery
falls after delivery
subsequently rises and peaks at day 3/4 post part
Values for a diagnosis of hypertension
> 140/90 mmHg on 2 occaisions
> 160/110 mmHg once
why does BP decrease in early pregnancy
reduced TPR (total peripheral resistance) due to vasodilation
risks of pre-existing hypertension in pregnancy
Pre-eclampsia
IUGR
Placental abruption
features of pregnancy induced hypertension
disease of the second half of pregnancy
resolves within 6 weeks of delivery
No proteinuria/oedema
features of pre-eclampsia
Hypertension, proteinuria, oedema
Proteinuria = >0.3g/L
pathogenesis of pre-eclampsia
Failure of trophoblast invasion- reducing blood flow to the placenta
Due to decreased placental perfusion, mother raises blood pressure to compensate
How can pre-eclampsia affect the CNS
Hypertensive encephalopathy
intra-cranial haemorrhage
Cerebral oedema
cranial nerve palsy
how can pre-eclampsia affect the resp system
Pulmonary oedema– ARDS
PE
how can pre-eclampsia affect the renal system
Decreased GFR
Increase serum uric acid, creatinine, potassium, urea
Acute renal failure- acute tubular necrosis, renal cortical necrosis
How can pre-eclampsia affect the liver
RUQ pain
abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome
what is HELLP syndrome
severe pre-eclampsia characterised by Haemolysis, Elevated liver enzymes, Low platelets
how can pre-eclampsia affect the placenta
IUGR
Placentral abruption
Intra-uterine death
symptoms of pre-eclampsia
Headache Visual disturbance RUQ pain Nausea + Vomiting Rapidly progressing oedema
Most significant risk factor for pre-eclampsia
previous pre-eclampsia
Other risk factors for pre-eclampsia
Maternal age >40 Maternal BMI >30 Family history First pregnancy Multiple pregnancy (e.g. twins)
Medical risk factors for pre-eclampsia
Pre-existing renal disease/ hypertension
Diabetes
Connective tissue disease
Thrombophilias
Investigations for pre-eclampsia
U + E Serum urate LFTs FBCs Coagulation screen Urine PCR CTG USS
what drug is used in high risk women to prevent pregnancy induced hypertension (PET)
75mg Aspirin
when should a woman be admitted
- BP >170/110 OR >140/90 with proteinuria
- Significant symptoms
- Abnormal biochemistry
- Significant proteinuria >300mg/24 hrs
- Need for antihypertensive therapy
- Signs of fetal compromise
What BP level requires treatment
> 150/100
What hypertension drugs are NOT safe in pregnancy
ACEi/ ARBs
Diuretics
1st line agent for hypertension
Labetolol 100mg bd
alpha + beta antagonist
