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Reproduction and sexual health > Hypertension in pregnancy > Flashcards

Hypertension in pregnancy Flashcards

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1
Q

What is the commonest cause of iatrogenic prematurity

A

Pre eclampsia

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2
Q

What BP readings classify as hypertension in pregnancy

A

> = 140/90 mmHg on 2 occasions

>160/110 mmHg once

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3
Q

What are the 3 groups of hypertensive disease in pregnancy

A

Pre-existing hypertension
Pregnancy induced hypertension (PIH)
Pre-eclampsia

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4
Q

When is diagnosis of pre-existing HTN made

A

Prior to pregnancy

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5
Q

When is PIH diagnosed

A

in 2nd half of pregnancy

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6
Q

When does PIH usually resolve by

A

within 6 weeks after delivery

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7
Q

What other symptoms of PIH are there

A

None, only HTN

No proteinuria or other features of pre eclampsia

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8
Q

There is a high rate of recurrence of PIH with future pregnancies, true or false

A

TRUE

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9
Q

What are the key features of pre eclampsia

A

Hypertension
Proteinuria >=0.3g/L
Oedema

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10
Q

Absence of one of the key features of PET rules out the disease, true or false

A

FALSE

PET can present in any way

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11
Q

define pre eclampsia

A

pregnancy specific multi-system disorder with unpredictable, variable and widespread manifestation

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12
Q

Women may be asymptomatic at first presentation of PET, true or false

A

TRUE

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13
Q

what systems are affected in PET

A 
Renal 
Hepatic 
CVS 
Haematology 
CNS 
Placenta 
Pulmonary
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14
Q

What are the classifications of PET

A

Early

Late

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15
Q

Describe early PET

A

<34 weeks
uncommon
associated with placental pathology
higher risks

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16
Q

Describe late PET

A

> = 34 weeks
more common form
tends to be more benign but if severe can increase risk of mortality

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17
Q

What are the 3 factors thought to play a role in the pathogenesis of PET

A

Genetic / environmental predisposition
Stage 1 = failure of placental development –> placental ischaemia
Stage 2 = maternal syndrome, anti angiogenic state

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18
Q

What happens to the spiral arteries in pre eclampsia

A

failure to turn into high capacity low resistance vessels and so get widespread endothelial damage

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19
Q

What is HELLP syndrome

A

Haemolysis
Elevated Liver enzymes
Low Platelets

Epigastric/RUQ pain
hepatic capsule rupture

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20
Q

What are consequences of placental disease in PET

A

FGR
IUD
placental abruption

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21
Q

List symptoms of PET

A 
Headache 
Visual disturbance 
Epigastric/RUQ pain 
N+V 
Rapidly progressive oedema
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22
Q

List signs of PET

A 
HTN 
Proteinuria 
Oedema 
Abdominal tenderness 
Disorientation 
SGA foetus 
IUD 
HYPER REFLEXIA / INVOLUNTARY MOVEMENTS / 
CLONUS
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23
Q

What sign must you check for in all women with PET

Study These Flashcards
A

Hyper reflexia

24
Q

What blood tests and investigations are done in PET

Study These Flashcards
A 
U+E
Serum urate 
LFT 
FBC 
Coagulation screen 
Urinary PCR 
CTG 
USS
25
What is the first biochemical marker seen to rise in PET
Serum urate
26
List RF for PET
``` age >40 BMI > 30 FH parity - 1st baby multiple pregnancy previous PE >10 year birth interval molar pregnancy pre existing renal disease pre existing hypertension Diabetes thrombophilias CTD ```
27
What does low dose aspirin do
inhibits COX and prevents TXA2 synthesis
28
Who gets LDA
high risk women
29
What is the dosing and timing of low dose aspirin
150mg started before 16 weeks
30
What is maternal uterine artery doppler MUAD
assesses resistance and capacity of spiral arteries
31
What is a normal MUAD
low resistance waveform
32
What is an abnormal MUAD
high resistance waveform | notching seen
33
MAP >=150mmHg increases risk of cerebral haemorrhage in mother, true or false
TRUE
34
At what blood pressure level do you treat
>=150/110 mmHg
35
What BP level requires immediate treatment
>=170/110mmHg
36
controlling BP does reduce the risk of developing PET, true or false
FALSE, it does not decrease the risk as the underlying pathology is still going on
37
What anti-hypertensive agents can be used in pregnancy
``` Labetolol - alpha and beta blocker Methyldopa - centrally acting alpha agonist Nifedipine - CCB Hydralazine - vasodilator Doxazocin - alpha antagonist ```
38
In whom is methyldopa contraindicated
Those with depression
39
In whom is labetolol contraindicated
Those with asthma
40
Is doxazocin safe in breast feeding
No
41
What is umbilical artery doppler and how does is differ from MUAD
Umbilical doppler measure placental flow from foetal aspect It is done in 3rd trimester MUAD looks at maternal aspect and is done at 20-24wks
42
What is the only cure for PET
Birth
43
What is the benefit of giving steroids to mother for pre term deliveries
allows for foetal lung maturation and prevents necrotising enterocolitis (NET)
44
What crises can occur in PET
``` Eclampsia! HELLP syndrome Pulmonary oedema Placental abruption Cerebral haemorrhage Disseminated intravascular coagulation Cortical blindness Acute renal failure Hepatic failure ```
45
What is eclampsia
tonic clonic seizure occurring with symptoms of pre eclampsia
46
What are the steps in management of eclampsia
1. Control BP - labetolol / hydralazine IV 2. stop/prevent seizures 3. fluid balance 4. deliver baby
47
What is given to stop or prevent eclamptic seizures
Magnesium sulphate
48
What is given for persistent eclamptic seizures
IV diazepam
49
What is ergometrine and why should it be avoided
It causes uterine contractions | It also raises BP
50
risk of magnesium sulphate and the drug to reverse this
respiratory depression | calcium gluconate
51
mechanism of action of magnesium sulphate
cerebral vasodilator
52
side effects of magnesium sulphate
``` impending doom facial flushing heat going up arm metallic taste N+V ```
53
Mg SO4 is a CNS depressant, true or false
true | may affect maternal and foetal CNS
54
signs of Mg SO4 toxicity
absent deep tendon reflexes slurred speech RR<10 - resp depression cardiac arrest
55
management of Mg SO4 toxicity
``` ABCDE + resus stop Mg SO4 call for help ECG Mg blood levels calcium gluconate ```
56
eclamptic seizures can occur post partum, true or false
true

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