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YEAR 3 REPRO > hypertension in pregnancy > Flashcards

hypertension in pregnancy Flashcards

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1
Q

what is needed to diagnose hypertension in pregnancy

A

bp > = 140/90 on 2 occasions
or
>= 160/110 on 1 occasion
or an increase from booking readings of > 30/15

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2
Q

what is pre-existing hypertension

A

diagnosis prior to pregnancy

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3
Q

if hypertension is found early in pregnancy what is it most likely to be

A

pre-existing

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4
Q

what are some risks of pre-existing hypertension

A

PET
IUGR
abruption

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5
Q

what is the time scale of pregnancy induced hypertension

A

from 20 weeks of pregnancy

resolves within 6 weeks of delivery

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6
Q

would you get proteinuria with PIH

A

no

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7
Q

is the rate of recurrence of PIH high or low

A

high

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8
Q

what are the 3 features of pre-eclampsia

A

hypertension
proteinuria
oedema

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9
Q

what is classed as proteinuria in pre-eclampsia

A

> 0.3g/L
or
0.3g/24hr

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10
Q

do all people with pre-eclampsia have oedema

A

no

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11
Q

can pre-eclampsia be asymptomatic

A

at time of presentation yes

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12
Q

why does BP fall in pregnancy initially

A

vasodilation

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13
Q

what is an organ largely affected by pre-eclampsia

A

liver

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14
Q

when does pre-eclampsia occur

A

after 20 weeks

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15
Q

what is the presentation of pre-eclampsia (9)

A 
hypertension
headache (cerebral oedema)
visual disturbance
papilloedema
RUQ/epigastric pain
sudden onset oedema
N+V
hyperreflexia, clonus 
platelets < 100 x 10^6/L, abnormal liver enzymes or HELLP syndrome
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16
Q

what is HELLP syndrome

A

haemolysis
elevated liver enzymes
low platelets
high morbidity/mortality

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17
Q

what is early pre-eclampsia

A

< 34 weeks

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18
Q

what is late pre-eclampsia

A

> = 34 weeks

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19
Q

what placental disease can pre-eclampsia cause

A

FGR
placental abruption
intrauterine death

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20
Q

what kind of pre-eclampsia is more common

A

late

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21
Q

what is early pre-eclampsia assoc. with re the placenta

A

extensive villous and vascular lesions

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22
Q

which kind of pre-eclampsia has a higher risk of complications

A

early

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23
Q

are there placental lesions in late pre-eclampsia

A

minimal

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24
Q

what are some RFs for pre-eclampsia

A 
HT disorder in previous pregnancy/HT 
CKD
CTD
thrombophilias 
AID e.g. SLE or APS
DM (type 1 or 2)
first pregnancy
age 40 +
pregnancy interval of 10+ years
BMI of 30 +
fmhx of PET
multiple pregnancy
previous PE
molar pregnancy/triploidy
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25
what can pre-eclampsia develop into if poorly controlled
eclampsia
26
what is the pathogenesis of pre-eclampsia generally
defective deep placentation - injured placenta then releases factors into the maternal circulation that induces pre-eclampsia
27
what is the first stage of pre-eclampsia pathophysiology
abnormal placental perfusion leading to placental ischaemia
28
what is the second stage of pre-eclampsia pathophysiology
maternal syndrome - anti-angiogenic state assoc. with endothelial dysfunction
29
what kind of state is maternal syndrome in pre-eclampsia
anti-angiogenic
30
pre-eclampsia involves abnormal placentation and ____ invasion
trophoblast
31
in pre-eclampsia _____ arteries fail to become low resistance leading to _____ damage and placental ischaemia
spiral arteries - fail to lose muscle layer widespread endothelial damage
32
in normal pregnancy what maintains endothelial health
VEGF | TGF-B1
33
what is secreted in excess in pre-eclampsia and antagonises VEGF and TGF-B1
sFit1 | sEng
34
what are the symptoms of pre-eclampsia
``` headache visual disturbance epigastric/RUQ pain N+V rapidly progressive oedema ```
35
what are the signs of pre-eclampsia
``` hypertension proteinuria oedema abdominal tenderness disorientation SGA fetus intra-uterine death hyperreflexia/involuntary movements/clonus ```
36
what what is the main cause of death in pre-eclampsia
pulmonary oedema
37
what investigations would you do for pre-eclampsia
``` BP U+E serum urate LFTs FBC coag screen urine - PCR CTG US ```
38
___ flow and ____ resistance are signs on uterine artery doppler of pre-eclampsia
low flow | high resistance
39
with hypertension before 20 weeks what should you look for
secondary cause
40
multiparous women develop more/less severe disease
more
41
how does aspirin work
inhibits cyclo-oxygenase preventing TXA2 synthesis
42
when should aspirin be commenced in high risk women
at 12 weeks (before 16 weeks)
43
what is the dose of aspirin in pre-eclampsia high risk patients
150mg
44
what would be seen on a maternal uterine artery doppler in pre-eclampsia
notching
45
when should you refer a patient to AN DCU
BP > 140/90 ++ proteinuria ^^ oedema symptoms esp a persistent headache
46
over what BP should a patient be admitted
170/110 or 140/90 with ++ proteinuria
47
what are other indicators that the patient should be admitted
signs of fetal compromise significant proteinuria (> 300) abnormal biochemistry significant symptoms
48
hypertensive inpatient: | how often to check BP
4 hourly
49
hypertensive inpatient: | how often is urinalysis done
daily
50
MAP > what is a significant risk of cerebral haemorrhage
150
51
a bp over what requires immediate treatment
170/110
52
does control of blood pressure reduce the risk of developing pre-eclampsia
no
53
what drugs are used in the treatment of pre-eclampsia
``` methyldopa labetolol nifedipine hydralazine doxazocin ```
54
what anti-hypertensive drugs should be avoided in pregnancy
ACEI ARB diuretics
55
what is methyldopa
centrally acting alpha agonist
56
when is methyldopa contraindicated
depression
57
what is labetolol
alpha and beta antagonist
58
when is labetolol contraindicated
asthma
59
``` are the following drugs ok in breastfeeding methyldopa labetolol nifedipine hydralazine doxazocin ```
all yes except doxazocin
60
what is nifedipine
calcium channel antagonist
61
what is hydralazine
vasodilator
62
what is doxazocin
alpha antagonist
63
what is the only definitive cure for pre-eclampsia
delivery
64
if a women is going to deliver baby preterm what should she be given and why
steroids - encourage surfactant production
65
pre-eclampsia increases the risk of developing what
``` eclampsia neonatal death IVH NEC placental abruption cerebral haemorrhage cortical blindness DIC AKD hepatic rupture ```
66
what is eclampsia
tonic-clonic grand mal seizure occurring with features of pre-eclampsia
67
eclampsia is more common in older women/teenagers
teenagers
68
hyperreflexia and clonus are examples of upper/lower MN signs
upper
69
umbilical artery doppler can be used to assess
blood flow in patient with known pre-eclampsia
70
how is severe PET/eclampsia managed
IV labetolo / IV hydralazine | IV magnesium sulfate
71
what does IV magnesium sulfate do in eclampsia/severe PET
stops/prevents seizures
72
what is the loading dose of magnesium sulfate
4g IV over 5 minutes
73
what is the maintenance dose of magnesium sulfate
IV infusion 1g/hr
74
how much magnesium sulfate should be administered if another seizure occurs
2g
75
what can be given if persistent seizures
diazepam 10mg IV
76
why are fluid challenges potentially dangerous in PET/eclampsia
main cause of death is pulmonary oedema
77
what kind of pain relief should be used in PET delivery
epidural
78
what drug should be avoided in delivery of PET
ergometrine
79
how should a baby be delivered if eclampsia
vaginal if fully dilated otherwise c section probably fasted

YEAR 3 REPRO (11 decks)

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