Hypertension in pregnancy Flashcards
(29 cards)
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
Hypertension in pregnancy has risks for both mother and child - give some foetal risks
- Asymmetrical IUGR
- Placental abruption
- Iatrogenic preterm delivery
Define pregnancy induced hypertension
New onset hypertension, greater than 140/80, after 20weeks gestation
What is hypertension present at booking/prior to 20 weeks or already controlled with an antihypertensive termed?
Chronic hypertension
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
True/false - isolated hypertension without proteinuria is unlikely to be a risk to mum
True
Define significant proteinuria
Greater than 300mg in 24hrs.
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
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
How does PIH typically present in a primigravida?
Late in third semester. Usually mild. Needs no intervention
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
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
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)
ACEIs are safe in pregnancy - true/false
false - Risk of foetal renal damage
Symptoms of pre-eclampsia include…
- Headache
- upper abdo pain
- reduced foetal movements
- oedema
(uncommonly may get visual changes, breathlessness and oliguria)
Risks for pre-eclampsia include…
- obesity
- > 35y/o
- multiple pregnancy
- pre-existing DM
- FHx
- renal disease
- chronic hypertension
Signs of pre-eclampsia include…
- hypertension
- proteinuria
- oedema
(also less commonly - hyper-reflexia and clonus)
What is the significant of b/lateral uterine artery notching?
Much higher risk of pre-eclampsia
What are the options for definitive treatment of PIH and pre-eclampsia?
No options except delivery - usually reverses immediately after delivery of placenta
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
When should delivery be performed for PIH/pre-eclampsia?
Ideally at/just after 36 weeks
If delivering before 32 weeks how should baby be delivered?
LUSCS
If delivering between 32 and 36 weeks how should baby be delivered?
Debated - can be either LUSCS or vaginal delivery with induction of labour
If delivering before 34 weeks what else do you need to give baby?
Steroids
