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HDP- Hypertensive Diseases in Pregnancy > HYPERTENSIVE DISEASES OF PREGNANCY > Flashcards

HYPERTENSIVE DISEASES OF PREGNANCY Flashcards

(39 cards)

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1
Q

What are the risk factors of HDP according to ISSHP?

A

CAMP MAP

  • chronic HT
  • anti-phospholipid syndrome(SLE)
  • Multiple pregnancy
  • Prior pre-eclampsia
  • maternal BMI > 35
  • Assisted reproduction
  • pre-gestational DM
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2
Q

What is the importance of HDP?

A
  • Leading cause of maternal mortality(MM) globally and 2nd leading in SA(18%)
  • eclampsia and pre-eclampsia are the leading HDP that cause death
  • since pre-eclampsia affects the endothelium, it is a multi-organ disease
  • 60% of HDP deaths due to substandard care
  • 75% of these are preventable
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3
Q

What’s the standard protocol of measuring BP?

A
  1. use a sphygmomanometer that’s indicated for pregnant women
  2. Woman must be in sitting position, legs uncrossed, relaxed, arm free of clothes at the level of the heart
  3. Hypertension>= 140/90mmHg. This should be checked again in 15 minutes if there are slight elevations in BP between 140-150mmHg
  4. Assess for obesity-BMI>=33 or MUAC >=35
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4
Q

What’s borderline BP/ pre-HT in low risk pregnant women and how is it dealt with and managed?

A

When systolic BP is 135-139 and diastolic BP is 85-99.

  • BP must be repeated within 30mins to 2hrs.
  • If still in this range, send home and call after 7 days.
  • If lower, pt is low risk and if still between range, pt has pre-HT

Administer 500mg Ca supplements daily for all pregnant woman at any gestational age to reduce pre-eclampsia

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5
Q

How is proteinuria detected and why is this important?

A
  • visual dipstix
  • protein:creatinine ratio>0.3 = proteinuria
  • 24hr urine>300mg = proteinuria

NB to detect proteinuria as it may indicate pre-eclampsia

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6
Q

When, why and how much aspirin should be given to pregnant women?

A
  • Started from 12-14 weeks and up to 20 weeks
  • should be given to prevent pre-eclampsia
  • 75-162mg/day aspirin(quarter to half) given daily
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7
Q

How should we examine and take history of a pregnant woman?

A
  • Big 5- CVS, renal, hepatic, GIT, neurological
  • Forgotten 4- haematology, endocrine, dermatological, musculoskeletal
  • core one- genitourinary
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8
Q

Name the basic HDP tests

A
  • urine-msc, protein:creatinine, 24hr urine test
  • blood-FBC for Hb and platelets, creatinine, ALT & LDH
  • sonar once mom is stable
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9
Q

How is HDP classified?

A

Chronic HT- before pregnancy and before 20 weeks gestation

White coat HT- HT at hospital but normal at home

Maternal HT- occurs after 20 weeks gestation

Pre-eclampsia- HT +/- proteinuria or organ dysfunction after 20 weeks of gestation.

HELLP syndrome- Hemolysis, Elevated Liver enzymes, Low Platelets

Eclampsia- more severe than pre-eclampsia and includes coma and seizures

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10
Q

What is the importance of HDP?

A
  • Leading cause of maternal mortality(MM) globally and 2nd leading in SA(18%)
  • eclampsia and pre-eclampsia are the leading HDP that cause death
  • since pre-eclampsia affects the endothelium, it is a multi-organ disease
  • 60% of HDP deaths due to substandard care
  • 75% of these are preventable
How well did you know this?
1
Not at all
2
3
4
5
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11
Q

How is HDP classified?

A

Chronic HT- before pregnancy and before 20 weeks gestation

White coat HT- HT at hospital but normal at home

Maternal HT- occurs after 20 weeks gestation

Pre-eclampsia- HT +/- proteinuria or organ dysfunction after 20 weeks of gestation.

HELLP syndrome- Hemolysis, Elevated Liver enzymes, Low Platelets

Eclampsia- more severe than pre-eclampsia and includes coma and seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name the basic HDP tests

A
  • urine-msc, protein:creatinine, 24hr urine test
  • blood-FBC for Hb and platelets, creatinine, ALT & LDH
  • sonar once mom is stable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How should we examine and take history of a pregnant woman?

A
  • Big 5- CVS, renal, hepatic, GIT, neurological
  • Forgotten 4- haematology, endocrine, dermatological, musculoskeletal
  • core one- genitourinary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When, why and how much aspirin should be given to pregnant women?

A
  • Started from 12-14 weeks and up to 20 weeks
  • should be given to prevent pre-eclampsia
  • 75-162mg/day aspirin(quarter to half) given daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is proteinuria detected and why is this important?

A
  • visual dipstix
  • protein:creatinine ratio>0.3 = proteinuria
  • 24hr urine>300mg = proteinuria

NB to detect proteinuria as it may indicate pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What’s borderline BP/ pre-HT in low risk pregnant women and how is it dealt with and managed?

Study These Flashcards
A

When systolic BP is 135-139 and diastolic BP is 85-89

  • BP must be repeated within 30mins to 2hrs.
  • If still in this range, send home and call after 7 days.
  • If lower, pt is low risk and if still between range, pt has pre-HT

Administer 500mg Ca supplements daily for all pregnant woman at any gestational age to reduce pre-eclampsia

17
Q

What’s the standard protocol of measuring BP?

Study These Flashcards
A
  1. use a sphygmomanometer that’s indicated for pregnant women
  2. Woman must be in sitting position, legs uncrossed, relaxed, arm free of clothes at the level of the heart
  3. Hypertension>= 140/90mmHg. This should be checked again in 15 minutes if there are slight elevations in BP between 140-150mmHg
  4. Assess for obesity-BMI>=33 or MUAC >=35
18
Q

How is HDP classified?

Study These Flashcards
A

Chronic HT- before pregnancy and before 20 weeks gestation

White coat HT- HT at hospital but normal at home

Maternal HT- occurs after 20 weeks gestation

Pre-eclampsia- HT +/- proteinuria or organ dysfunction after 20 weeks of gestation.

HELLP syndrome- Hemolysis, Elevated Liver enzymes, Low Platelets

Eclampsia- more severe than pre-eclampsia and includes coma and seizures

19
Q

Name the basic HDP tests

Study These Flashcards
A
  • urine-msc, protein:creatinine, 24hr urine test
  • blood-FBC for Hb and platelets, creatinine, ALT & LDH
  • sonar once mom is stable
20
Q

How should we examine and take history of a pregnant woman?

Study These Flashcards
A
  • Big 5- CVS, renal, hepatic, GIT, neurological
  • Forgotten 4- haematology, endocrine, dermatological, musculoskeletal
  • core one- genitourinary
21
Q

When, why and how much aspirin should be given to pregnant women?

Study These Flashcards
A
  • Started from 12-14 weeks and up to 20 weeks
  • should be given to prevent pre-eclampsia
  • 75-162mg/day aspirin(quarter to half) given daily
22
Q

How is proteinuria detected and why is this important?

Study These Flashcards
A
  • visual dipstix
  • protein:creatinine ratio>0.3 = proteinuria
  • 24hr urine>300mg = proteinuria

NB to detect proteinuria as it may indicate pre-eclampsia

23
Q

What’s borderline BP/ pre-HT in low risk pregnant women and how is it dealt with and managed?

Study These Flashcards
A

When systolic BP is 135-139 and diastolic BP is 85-99.

  • BP must be repeated within 30mins to 2hrs.
  • If still in this range, send home and call after 7 days.
  • If lower, pt is low risk and if still between range, pt has pre-HT

Administer 500mg Ca supplements daily for all pregnant woman at any gestational age to reduce pre-eclampsia

24
Q

What’s the standard protocol of measuring BP?

Study These Flashcards
A
  1. use a sphygmomanometer that’s indicated for pregnant women
  2. Woman must be in sitting position, legs uncrossed, relaxed, arm free of clothes at the level of the heart
  3. Hypertension>= 140/90mmHg. This should be checked again in 15 minutes if there are slight elevations in BP between 140-150mmHg
  4. Assess for obesity-BMI>=33 or MUAC >=35
25
What is the importance of HDP?
- Leading cause of maternal mortality(MM) globally and 2nd leading in SA(18%) - eclampsia and pre-eclampsia are the leading HDP that cause death * since pre-eclampsia affects the endothelium, it is a multi-organ disease - 60% of HDP deaths due to substandard care - 75% of these are preventable
26
Which features suggest pre-eclampsia?
- HT<32 weeks gestation - IUGR - isolated proteinuria - HT and proteinuria
27
What are steroids used for after 34 weeks gestation
Stimulate feral lung maturity when pre-eclampsia with severe features is indictated.
28
What are the steps to stabilise a woman?
* call for help * ABC * IV saline(restore fluids and electrolytes) and ringers lactate( restore circulating blood volume in burn and trauma victims) * MgSO4 to prevent seizures * BP reduction using 10mg oral nifedipine (every 30 minutes if BP doesn’t drop below 160/110) * administer oral a-methyldopa * check if fetus is alive and only monitor(sonar) once mom is stable and she will deliver at a DH * insert urinary catheter and monitor every hour for urine output until transferred * monitor vitals every 15 mins until transferred * during transfer mom accompanied by nurse and SBAR( situation, background, assessment, recommendation) form * mom must be monitored in the lateral position
29
What is the immediate assessment during initial stabilisation
- shake and shout - ABC - Lateral position - IV - MgSo4 - Examine: big 5, forgotten 4, core 1
30
How is Magnesium sulphate administered?
* loading(14g) - 4g in 200ml normal saline IV over 20 mins - 5g in 1ml 2% lignocaine(local anaesthetic and anti-arrhythmic drug) IM in each butt *maintenance -5g in 1ml lignocaine IM every 4 hours (until 24hrs after birth or 24hrs after last convulsion) -1g in 2ml in solution( MgSo4 always 50% solution) !!!assess urine output, RR and reflexes before re-administration. !!! If convulsions adminster 2g IV over 10-15 mins
31
When should the next dose of magnesium not be administered?
- Absent knee jerk - Urine output< 100mls in last 4 hours - Respiratory rate < 16BPM( administer calcium gluconate 10% 1g IV over 10 minutes)
32
What are the indications of MgSO4?
* Pre-eclampsia with severe features * imminent eclampsia * eclampsia * uncontrolled BPs * concern with transferring
33
How is BP> 160/110 managed?
1ST LINE - 10mg oral nifedipine repeated every 30 minutes(max 4 times) or until BP<160/110 * Contra- indications - pulse>120 - cardiac lesion - unable to swallow 2ND LINE- labetolol(from 20 to 300mg) every 10 mins until BP< 160/110 * Contra-indications - asthma - IHD
34
How is fluid managed?
- catheter and monitor input and output - IV 200ml NaCl or 80ml/hr RL (loading dose) * if output<25ml/hr give 200ml RL once
35
When is delivery indicated for a mom with pre-eclampsia?
MATERNAL COMPLICATIONS at term or preterm: (CHOP CRUE)- recommend termination - CVA - HELLP - Organ dysfunction - Pulmonary oedema - Renal dysfunction (crest>120) - Uncontrolled BP - coagulaopathy (platelets<100 twice) - Eclampsia 28-33 WEEKS - first give corticosteroids * if unstable or with severe features, deliver after 48hrs if mom STABLE( no eclampsia, HELLP, or severe features ;normal bloods; controlled BP) * if stable and GA < 34 weeks , council and inform of expected care at the hospitals >=34 weeks - inform mom of risks * neurological impairment * immature lungs and RDS * SIDS * NEC * ROP
36
Discuss the induction of labour in hypertension
* with eclampsia - urgent( 6hrs to get to labour. Delivery 12 hrs after induction) - favourable cervix - high care monitoring available - skilled doctors * without eclampsia - induce labour even if cervix is not favourable
37
What is the proper post-op care in pre-eclampsia?
- monitor chart - VTE - don’t discharge before 24hrs and administer MgSO4 for 24hrs - if eclampsia and organ dysfunction, keep in hospital for at least 3 days - stop antiHT (CCB and/or diuretics after 48hrs; ACEi and diuretics postpartum) gradually - provide contraception - counsel before discharge
38
List post partum anti-HTs?
ACEi -oral enalopril 5mg to 20mg/day CCB -amlodipine 5mg to 10mg/day BB -atenolol 50mg to 100mg/day
39
List the warning signs of imminent eclampsia
- SP>160mmHg more than 2 times, 6 hours apart - proteinuria - oliguria - cerebral/visual disturbances - pulmonary oedema or cyanosis - epigastric, chest pain - liver dysfunction - thrombocytopenia and other coagulopathy

HDP- Hypertensive Diseases in Pregnancy (4 decks)

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