Hypertensive disorders

Question 1

list 5 things about chronic hypertension

Answer 1

a long term condition that consists of raised blood pressure that occurs before pregnancy. If CHT is not diagnosed pre-pregnancy it may be seen as IH - cannot be differentiated until 6 weeks postnatal.

in the first trimester marked vasodilatation causes a decreases in vascular resistance - therefore women with CHT may not be hypertensive until later in pregnancy.

monitoring of BP at every AN appointment and appropriate referral if >140 / >90, at risk of IUGR therefore SFH at every appointment, urinalysis for proteinuria, as if symptomatic for PET

hypertensive drugs such as; labetalol, nifedipine, methyldopa (not midwives role) just ensure compliance with medication

NICE, RCOG continuous fetal monitoring in labour

hourly bp in labour

do not use syntometrine or ergometrine for 3rd stage as causes vasoconstriction

methyldopa should be changed PNally

no antihypertensive drugs contraindicate breastfeeding

Question 2

list 5 things about pre eclampsia

Answer 2

PET - pre eclamptic toxaemia

pregnancy specific syndrome categorised by variable degrees of placental dysfunction, maternal hypertension and proteinuria. major cause of maternal and fetal mortality and morbidity.

resolves postnatally

10% of women will have hypertension in pregnancy, 3-4% of these will have PET

exact aetiology of the condition remains unclear

causes placental problems problems including inappropriate activation of endothelial cells in the walls of placental blood vessels which leads to various biochemical substances being released into the circulation.

risk factors for preeclampsia are:
extremes of maternal age
primiparity
chronic hypertension
family history
previous PET

imperative for diagnosis and management due to risks to mum and fetes

accurate blood pressure monitoring -correct size cuff

FBC, U&E, LFT, PCR, 24 hour urine collection?

BP checks daily when discharged until day 5

may need one to one HDU care including urine output, reflex assessment, rest rate and BP checks

potential for preterm birth

Question 3

list 5 things about HELLP syndrome

Answer 3

Haemolysis, Elevated Liver enzymes, Low Platelets.

a multi-system disorder characterised by activation of the coagulation system leading to increased deposition of the protein fibrin throughout the body.

often presents as signs of severe pre-eclampsiam even can cause epigastric pain however with HELLP it will not ease with antacids

complications are:
DIC
placental abruption
acute renal failure
pulmonary oedema
liver haematoma and rupture.

blood pressure control with appropriate antihypertensives

fluid restriction to prevent pulmonary or cerebral oedema

IV mag sulfate

1:1 HDU care