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Midwifery Emergencies > Hypertensive disorders > Flashcards

Hypertensive disorders Flashcards

(58 cards)

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1
Q

What is the definition of hypertension in pregnancy?

A

2 x readings pf 140/90 at least 4 hours apart
or
1 diastolic reading of 110

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2
Q

What are the 3 types of hypertension?

A

mild
moderate
severe

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3
Q

What is mild hypertension?

A

140-149/

90-99

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4
Q

What is moderate hypertension?

A

150-159/

100-109

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5
Q

What is severe hypertension? (emergency)

A

160+/110+

MAP of 125+

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6
Q

When does BP lower?

A

second trimester

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7
Q

What is MAP?

A

mean arterial pressure - average or mean value for arterial pressure represents pressure driving the blood through the arteries

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8
Q

How do you calculate map?

A

diastolic pressure+ 1/3 (systolic pressure - diastolic pressure)

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9
Q

What is chronic hypertension?

A

hypertension that predates a pregnancy or appears prior to 20/40 - may be superimposed or secondary to another medical condition

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10
Q

What is gestational hypertension?

A

New hypertension presenting after 20 weeks without significant proteinurea

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11
Q

What is pre-eclampsia?

A

Hypertension new to pregnancy manifesting after 20 weeks associated with new onset of proteinurea

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12
Q

What is severe pre-eclampsia?

A

pre-eclampsia with severe hypertension (160+/110+)

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13
Q

What is eclampsia?

A

convulsive condition associated with pre-eclampsia

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14
Q

When does gestational hypertension resolve?

A

usually 6 weeks postnatally

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15
Q

What is pre-eclampsia caused by?

A

Widespread endothelial cell damage secondary to ischaemic placenta

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16
Q

What risks are there for later life if you have pre-eclampsia?

A

Hypertension and cardiovascular disease

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17
Q

Lower/other risk factors for pre-eclampsia

A
  • new partner
  • booking bp /80+ or booking proteinurea 1+
  • 1+ protein on more than one
  • latin american or carribean
  • donor eggs - other DNA
  • postpartum - headache for 1-3 days
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18
Q

What can women be prescribed at booking if higher risk?

A

75mg aspiring from 12 weeks till birth

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19
Q

what does aspirin do?

A

changes how the placenta imbeds

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20
Q

What are the 5 high risk factors?

A
  • prev hypertensive disorder in pregnancy
  • chronic kidney disease
  • autoimmune disease
  • type 1 or 2 diabetes
  • chronic hypertension
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21
Q

What are the moderate risk factors?

A
  • primip
  • age 40+
  • pregnancy interval of 10+ years
  • BMI or 35+
  • family hx of pre-eclampsia
  • multiple pregnancy
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22
Q

Antenatatal symptoms

A
  • new hypertension
  • new or significant proteinurea >1+
  • mat symptoms of headache or visual disturbances
  • epigastric pain or vomiting
  • rfm or small for dates
  • sudden and marked oedema- face/hands/ feet
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23
Q

Signs of severe pre-eclampsia

A 
-hypertension >160/110 with proteinuria 
OR 
->3+ proteinurea 
OR 
-thrombocytopenia - reduced platelets (<100)
-creatinine >100 mmol/l
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24
Q

What are the 8 maternal complications of pre-eclampsia?

Study These Flashcards
A
  • intracranial haemorrhage
  • placental abruption
  • eclampsia
  • HELLP syndrome
  • Disemminated intravascular coagulation
  • Renal failure
  • Pulmonary oedema
  • Acute respiratory distress syndrome
25
What is the leading cause of death from severe pre-eclampsia in the UK?
intracranial haemorrhage
26
What is HELLP syndrome?
H- haemolysis EL- elevated liver enzymes LP- low platelets
27
What is Disemminated intravascular coagulation?
A condition in which blood clots form throughout the body's small blood vessels which reduce or block floor- damages organs. The increased clotting uses up platelets and clotting factors. With less of thees, serious bleeding can occur. It can cause internal and external bleeding.
28
What is renal failure?
Due to not passing urine, increased fluid in the body leaks into the tissues due to high blood pressure, leads to oedema
29
What is acute respiratory distress syndrome?
infections, injuries and other conditions cause fluid to build up in air sacs. Prevents lungs from filling with air and moving enough oxygen into the bloodstream.
30
What are fetal complications of pre-eclampsia?
- fetal growth restriction - oligohydramnios - hypoxia from placental insufficiency - placental abruption - premature delivery
31
Clinical signs of pre-eclampsia
- BP 160-180 or /110 - MAP >125 - protein 3+ in 24 hrs - elevated serum creatinine - elevated liver enzymes - oliguria - pulmonary oedema - microangiopathic haemolysis - thrombocytopenia - cerebral or visual disturbances - epigastric pain - hyperreflexia - more twitchy on relfex tests more likely to fit
32
What happens to bloods in pre-eclampsia?
- + haemoglobin due to haemoconcentration - + haematocrit due to -plasma volume - leaking out - - platelets due to aggregation following damage to lining of blood vessels - + uric acid - serial measurements more useful - + urates
33
What is haematocrit?
how much space in the blood is occupied by red blood cells - if they take up more space they are usually bigger and vice versa
34
When do we act for high blood pressure?
- check BP and urinalysis at every visit - systolic >150 - hypertensives - systolic >180 - emergency - if >140 or /90 2x or immediately after birth - consultant unit
35
What is the timing of eclampsia?
38% antenatally 18% intrapartum 44% postnatally
36
What is the death rate for those who have eclamptic fits?
2%
37
Management of eclampsia - basic
- key people told - basic life support - abc - prevent seizures - mag sulf - lower bp - labetalol oral/IV OR nifedipine oral OR hydralazine IV
38
What are the drugs used to lower BP in emergencies?
1st line - labetalol 2nd line - nifidipine 3rd line- hydralazine
39
How do we give labetalol?
- initial oral dose 200mg - second oral dose given if needed - maintenance dose 200mg - If oral not working or non tolerable - IV - Bolus 50mg IV given over 5 minutes - repeat if BP >160/105 in doses of 50mg up to 200mg at 10 minute intervals - After give infusion of labetalol 5mg/hour at a rate of 4ml/hr - double rate every 1/2 hour up to 32 ml/hour - bradycardia countered with IV atropine sulphate 0.6-2.4mg in divided doses of 600mcg
40
When should we not give labetalol?
asthmatic | afrocarribean
41
What does labetalol do?
beta blocker- blocks beta receptors with control heart rate and smooth muscle contractility - compete with adrenaline - reduces peripheral resistance - protects heart from reflex sympathetic drive
42
What is methyldopa for?
mild-moderate hypertension in pregnancy, also known as aldomet. acts on brain stem. counteracts effects of epinephrine, norepinephrine and dopamine. inhibits sympathetic nervous system causing vasodilation and bradycardia
43
How do we give nifedipine?
- 10mg orally - repeat every 30 mins until max 30mg given - can be given with labetalol - may give if map >120 - calcium channel blocker - maintenance dose 10mg qds
44
What does nifidipine do?
inhibits passage of calcium ions into smooth muscle reducing contractility allows arterioles to dilate and decreases bp hr increases which can cause myocardial ischaemia
45
How do we give hydralazine
Bolus given 5mg over 15mins Can give further 5mg after 20 mins if BP >160 -Maintenance IVI starting at 5ml/hr to titrate BP to 140-150 -usual rate 2-3ml/hr -reduce rate if mat hr >120
46
What can rapid reduction in BP cause?
cardiovascular collapse myocardial ischaemia compromise fetal oxygen supply
47
3 main ways to manage eclampsia
monitor symptoms maintain fluid balance expedite delivery
48
How do we monitor symptoms for eclampsia?
- hourly basic obs - resps - neurological obs - sats - ECG - CVP - urgent bloods - CTG
49
How do we maintain fluid balance for eclampsia?
- restrict hourly input - 1ml/kg/hr | - hourly urine output via urometer
50
What can overloading fluid cause?
pulmonary oedema
51
What should be controlled before a CS under GA?
BP
52
Why should BP be controlled for GA?
pressor effects of intubation- intubation increases BP, reflex response and is momentary but can be enough to raise intracranial pressure
53
What are the 3 outcomes of extremely high BP?
Give anti- hypertensive Placental abruption Intracranial haeomorrhage
54
What does a sudden drop in bp and no antihypertensive given mean?
bleeding
55
What should you consider for pre-eclamptic women for an epidural?
- Low platelets- risk of bleeding | - Fluid before due to hypotension- could cause fluid overload in PET women
56
What are the signs of magnesium toxicity?
1. loss of reflexes 2. somnolence 3. respiratory depression 4. paralysis 5. cardiac arrest
57
What is the antidote to magnesium toxicity?
calcium gluconate
58
What is magnesium toxicity?
hypermagnesemia

Midwifery Emergencies (7 decks)

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