Hypertension in pregnancy Flashcards Preview

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Flashcards in Hypertension in pregnancy Deck (29):
1

Hypertension in pregnancy has risks for both mother and child - give some maternal risks

- CVA
- Renal failure
- Heart failure
- Coagulation failure
- Liver failure
- Adrenal failure
- (Pre)/eclampsia

2

Hypertension in pregnancy has risks for both mother and child - give some foetal risks

- Asymmetrical IUGR
- Placental abruption
- Iatrogenic preterm delivery

3

Define pregnancy induced hypertension

New onset hypertension, greater than 140/80, after 20weeks gestation

4

What is hypertension present at booking/prior to 20 weeks or already controlled with an antihypertensive termed?

Chronic hypertension

5

How is pregnancy induced hypertension (PIH) classified?

Mild; 140-149 systolic or 90-99 diastolic
Moderate; 150-159 systolic or 100-109 diastolic
Severe; >160 systolic or >110 diastolic

6

True/false - isolated hypertension without proteinuria is unlikely to be a risk to mum

True

7

Define significant proteinuria

Greater than 300mg in 24hrs.

8

What are the risks for PIH and pre-eclampsia?

- Primigravidae
- had them severe in first pregnancy
- Changed partners between pregnancies
- pregnancy complicated by Hydatidiform mole
- GDM
- Antiphospholipid syndrome
- Multiple pregnancy

9

Give a BRIEF summary of the cause of pre-eclampsia

1) Failure of second wave trophoblast invasion
2) Altered prostacyclin/thromboxane ratio
3) Failure to reduce peripheral resistance
4) BP high throughout
5) Decreased perfusion of intervillous space and so asymmetrical growth restriction

10

How does PIH typically present in a primigravida?

Late in third semester. Usually mild. Needs no intervention

11

For moderate PI hypertension, you should treat - how?

Oral labetalol - no need to admit. Aim for BP less than 150/100 and diastolic greater than 80

12

For severe PI hypertension, you should treat - how?

Admit and treat with labetalol first line until BP >159/109. Monitor BP QDS in hospital. Monitor U+Es, FBC, transaminases and bili on admission and at least 1xweekly

13

What else can you give if the patient can't take labetalol or you need a second agent?

Nifedipine (calcium channel blocker licensed in pregnancy)

14

ACEIs are safe in pregnancy - true/false

false - Risk of foetal renal damage

15

Symptoms of pre-eclampsia include...

- Headache
- upper abdo pain
- reduced foetal movements
- oedema
(uncommonly may get visual changes, breathlessness and oliguria)

16

Risks for pre-eclampsia include...

- obesity
- >35y/o
- multiple pregnancy
- pre-existing DM
- FHx
- renal disease
- chronic hypertension

17

Signs of pre-eclampsia include...

- hypertension
- proteinuria
- oedema
(also less commonly - hyper-reflexia and clonus)

18

What is the significant of b/lateral uterine artery notching?

Much higher risk of pre-eclampsia

19

What are the options for definitive treatment of PIH and pre-eclampsia?

No options except delivery - usually reverses immediately after delivery of placenta

20

What is the mainstay of treatment for PIH and pre-eclampsia?

Prevent progression and deterioration using antihypertensives (labetalol/nifedipine/methydopa_ and anti-convulsants (magnesium sulphate) to prevent full eclampsia

21

When should delivery be performed for PIH/pre-eclampsia?

Ideally at/just after 36 weeks

22

If delivering before 32 weeks how should baby be delivered?

LUSCS

23

If delivering between 32 and 36 weeks how should baby be delivered?

Debated - can be either LUSCS or vaginal delivery with induction of labour

24

If delivering before 34 weeks what else do you need to give baby?

Steroids

25

If delivering at 36 weeks, how should baby be delivered?

By vaginal delivery unless otherwise contraindicated

26

Eclampsia is uncommon in the UK - but what is it?

Seizures
with moderate to severe hypertension

27

What causes the seizure?

Cerebral oedema and cerebral vasoconstriction
Results in hypoxia and a typical epileptiform fit

28

What type of seizure is present in eclampsia?

Epileptiform - with twitching, tonic phase, clonic phase and post-icthal stage.

29

How do you manage eclampsia?

Magnesium sulphate to reduce frequency and severity of seizures
ABCDE - turn on side and maintain airway. Consider IV lorazepam Urgent and immediate delivery of the baby.