Hypertension in Pregnancy Flashcards
(41 cards)
what percentage of pregnant women get hypertension
10-15%
mild pre-eclampsia affects 10% of Primigravid women
what is the biggest cause of iatrogenic preterm birth
pre-eclampsia
only cure is delivery
what CVS changes are there in pregnancy
increase in:
- plasma volume
- cardiac output
- stroke volume
- heart read
peripheral vascular resistance decreases
definition of hypertension in pregnancy
> 140/90 on two occasions
> 160/110 once
what are the types of hypertension you get in pregnancy
pre-existing hypertension
pregnancy induced hypertension (PIH)
Pre-eclampsia (PET)
when do PIH and PET resolve
within 3 months after delivery
if not -could have been pre-existing hypertension
risks associated with pre-existing hypertension
PET (risk doubled)
Intrauterine growth restriction
Placental abruption
what is pregnancy induced hypertension
hypertension that occurs in pregnancy - usually in the second half of pregnancy
most commonly resolves within 6 weeks of birth
better outcomes than pre-eclampsia
15% progress to PET - depends on gestation (earlier diagnosed more likely to progress to PET)
recurrence is common in other pregnancies
what is pre-eclampsia
Hypertension
Proteinuria (>0.3g/l or >0.3g in 24 hours)
Oedema
Absence does not exclude the diagnosis
what causes pre-eclampsia
diffuse vascular endothelial dysfunction
widespread circulatory disturbance
affects all organs in the mother and can also affect the baby
what is early pre-eclampsia
pre-eclampsia <34 weeks
uncommon
associated with placental pathology
higher risk of adverse maternal and fetal outcomes
what is late pre-eclampsia >34 weeks
minimal placental disease
maternal factors more common cause (eg. previous hypertension, metabolic syndrome)
what is the pathogenesis behind pre-eclampsia
genetic/environmental predisposition
stage 1- abnormal placental perfusion - placental ischameia
stage 2 - maternal syndrome - an anti-angiogenic state associated with endothelial dysfunction
what systems are involved in pre-eclampsia
CNS Renal Hepatic Haematological Pulmonary Cardiovascular Placental
what liver disease is caused by pre-eclampsia
Epigastric/ RUQ pain
Abnormal liver enzymes
Hepatic capsule rupture
HELLP syndromes,e
Haemoloysis
Elevated liver enzymes
Low platelets
what does placental disease cause
Fetal growth restriction
Placental abruption
Intrauterine death
symptoms of pre-eclampsia
headache visual disturbance epigastric/RUQ pain Nausea/vomiting Rapidly progressive oedema
considerable variation in timing, progression and order of symptoms
Signs of pre-eclampsia
Hypertension Proteinuria Oedema Abdominal tenderness Disorientation Small for gestational age deus Intrauterine fetal death Hyper-reflexia/involuntary movements/clonus
Investigations for pre-eclampsia
Urea and electrolytes Serum urate (usually rises in PET) Liver function tests (look for HELLP) Full blood count Coagulation screen Urine-protein creatinine ratio Cardiotocography Ultrasound for dental assessment
management of hypertension in pregnancy
Asses risk at booking If hypertension <20 weeks- look for secondary cause Antenatal screening - BP, urine Treat hypertension Maternal and fetal surveillance Timing of delivery
what are risk factors for pre-eclampsia
age >40 BMI >30 (doubles risk) Family history Parity (first pregnancy 2-3x increased risk) Multiple pregnancy Previous Pre-eclampsia Birth interval >10 years (doubles risk) Molar pregnancy/triploidy Multiparous women develop more severe disease
medical risk factors for pre-eclampsia
pre-existing renal disease pre-existing hypertension diabetes connective tissue disease thrombophilias (congenital or acquired (antiphospholipid syndrome))
how do you minimise the risk of risk factors for the mother
Low Dose Aspirin
-inhibits cyclo-ocygenase on the prostaglandin pathway and prevents TCA2 synthesis
therefore prevents thrombosis in the placenta
15% reduction in risk of pre-eclampsia and prevents most severe forms of disease
what dose of aspirin do you give mothers at increased risk
150mg dose
