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Midwifery Emergencies > Hypertensive disorders > Flashcards

Hypertensive disorders Flashcards

(54 cards)

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1
Q

Chronic hypertension

A

Is hypertension that is present at booking or before 20/40, or if the women is already taking antihypertensive medication
(NICE 2011b)

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2
Q

Eclampsia

A

Is a convulsive condition associated with pre-eclamspia

NICE 2011b

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3
Q

HELLP syndrome

A

Haemolysis
Elevated Liver enzymes
Low Platelet count
(NICE 2011b)

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4
Q

Gestational hypertension

A

Is new hypertension presenting after 20 weeks without significant proteinuria
(NICE 2011b)

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5
Q

Pre-eclampsia

A

Is new hypertension presenting after 20 weeks with significant proteinuria
(NICE 2011b)

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6
Q

Severe pre-eclampsia

A

Is pre-eclampsia with severe hypertension and/or with symptoms, and/or biochemical and/or haematological impairment
(NICE 2011b)

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7
Q

Definitions of hypertension

A

Mild hypertension = diastolic 90-99 mmHg + systolic 140-149 mmHg
Moderate hypertension = diastolic 100-109 mmHg + systolic 150-159 mmHg
Severe hypertension = diastolic 110 mmHg or greater + systolic 160 mmHg or greater
(NICE 2011b)

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8
Q

Mean arterial pressure (MAP)

A

Is useful as represents the pressure driving the blood through the arteries
MAP = diastolic pressure + 1/3 systolic pressure - diastolic pressure

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9
Q

Incidence of PIH and pre-eclampsia

A

Pregnancy induced hypertension = 12%
Pre-eclampsia = 3-5%
(Mayes 2012)

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10
Q

How many deaths is pre-eclampsia responsible for?

A

6 maternal deaths between 2014-2016

MBRRACE 2018

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11
Q

When and why is there a normal drop in blood pressure?

A

Physiological dilatation of the spiral arterioles in the placental bed occurs, by stripping away their muscle coating. This allows the pooling of blood in the intervillous spaces of the placental bed, creating a shunt, which lowers the maternal blood pressure. This occurs at 16-18 weeks.
(Mayes 2012)

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12
Q

Risks later in life for women who had pre-eclampsia

A

Increased risk of hypertension and cardiovascular disease

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13
Q

What is the only cure for pre-eclampsia?

A

Delivering the baby

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14
Q

Care for women who are at high risk of pre-eclampsia

A

Advise to take 75mg of aspirin daily from 12 weeks until the birth of the baby

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15
Q

Women who are at high risk are those with any of the following …

A 
- Hypertensive disease during 
  a previous pregnancy 
- Chronic kidney disease 
- Autoimmune disease such as 
  systemic lupus or 
  antiphospholipid syndrome 
- Type 1 or 2 diabetes 
- Chronic hypertension
(NICE 2011b)
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16
Q

Advised to take aspirin if there are 2 or more moderate risk factors:

A
  • First pregnancy
  • Maternal age over 40
  • Pregnancy interval of more
    than 10 years
  • BMI over 35 at booking
  • Family history of pre-
    eclampsia
  • Multiple pregnancy
    (NICE 2011b)
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17
Q

Symptoms of pre-eclampsia to assess antenatally

A
  • Severe headache
  • Problems with vision such
    as blurring or flashing
    before the eyes
  • Severe pain just below the
    ribs (epigastric pain)
  • Vomiting
  • Sudden swelling of the face,
    hands or feet
    (NICE 2011b)
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18
Q

Effects of pre-eclampsia on the central nervous system

A
  • Cerebral haemorrhage
  • Eclampsia (seizures)
  • Cerebral oedema
  • Retinal oedema/retinal
    blindness
    (Mayes 2012)
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19
Q

Effect of pre-eclampsia on the pulmonary system

A
  • Pulmonary oedema
  • Laryngeal oedema
    (Mayes 2012)
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20
Q

Effect of pre-eclampsia on the renal system

A
  • Cortical necrosis
  • Tubular necrosis
    (Mayes 2012)
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21
Q

Effect of pre-eclampsia on the liver

A
  • HELLP syndrome
  • Hepatic rupture
  • Jaundice
    (Mayes 2012)
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22
Q

Effect of pre-eclampsia on the haematological/coagulation system

Study These Flashcards
A 
- Disseminated 
  intravascular coagulation 
  (DIC)
- Haemolysis 
(Mayes 2012)
23
Q

Effect of pre-eclampsia on the placenta

Study These Flashcards
A
  • Placental abruption
  • Placental ischaemia/infarction
    (Mayes 2012)
24
Q

Effect of pre-eclampsia on the fetus/neonate

Study These Flashcards
A
  • IUGR
  • Prematurity
  • Low birth weight
  • Intrauterine hypoxia leading
    to neurological
    complications
  • Perinatal death
    (Mayes 2012)
25
What is DIC?
A condition in which blood clots form throughout the body's small blood vessels. These blood clots can reduce or block blood flow through the blood vessel, which can damage the body's organs. The increased clotting uses up platelets and clotting factors in the blood. With fewer platelets and clotting factors in the blood, serious bleeding can occur
26
What is pulmonary oedema?
Is when there is fluid in the lungs causing shortness of breath. Sit the women right up
27
Assessment of renal functions
``` - Uric acid levels indicate progress and severity of pre- eclampsia, with increased levels in cases of hypertension, usually before the development of proteinuria - Blood urea and creatinine levels may be raised, and a high level (>110 micromol/L) indicate a late stage of renal involvement - 24 hour urinary protein excretion of ≥0.3 g/24 hours indicates renal involvement (Mayes 2012) ```
28
Assessment of liver function
Serial measurement of liver enzymes, particularly ALT or AST, and where these raise above 70 IU, liver function tests may be carried out (Mayes 2012)
29
Assessment of coagulation complications
- Blood film - Platelet count which often decreases below 100 x 10⁶/L in pre-eclampsia - Coagulation studies whereby coagulation levels are usually unchanged in pre-eclampsia, unless DIC is present (Mayes 2012)
30
Assessment of fetal wellbeing
- CTG - Measure SFH - Record fetal movements - USS if necessary (Mayes 2012)
31
What bloods to be taken 48-72 hours after birth?
Platelet count Transaminases Serum creatinine (NICE 2011b)
32
Incidence of pre-eclampsia developing into eclampsia
One in 200 women | Mayes 2012
33
What to do during a seizure?
- Remain with the women - Call for help - Clear the airway of mucus and blood and maintain a clear airway, using the recovery position - Turn the women onto her left side - Protect her from injury - Administer oxygen Remember ABC (Mayes 2012)
34
Observations for eclampsia
``` - Restlessness or twitching may indicate a seizure - Continuous oxygen saturation should be measured. Cyanosis is an important sign of cardiorespiratory failure - Temperature recorded hourly. If there is no obvious signs of infection, a rise in temperature could indicate anoxic damage to the temperature-regulating centres in the midbrain - Pulse and respirations may be recorded as often as every 5 minutes - BP recorded frequently, usually every 15 minutes - An accurate record of fluid intake and output is essential. A self-retaining catheter is inserted into the bladder and released hourly; thus urinary output can be measured accurately and the women will not have to be distrubed to pass urine. - Urine is tested for protein - FH continuously monitored - Monitor for signs of labour (Mayes 2012) ```
35
What is the minimum urine output?
Less 30ml/hour suggests renal impairment | Mayes 2012
36
What is the only drug to manage eclamptic seizures?
Magnesium sulphate | Prompt 2017
37
Loading dose of magnesium sulphate
4g magnesium sulphate IV over 5 minutes | Prompt 2017
38
Maintenance dose of magnesium sulphate
1g/hour and continue maintenance infusion for 24 hours following birth or the last seizure (whatever is first) (Prompt 2017)
39
Magnesium toxicity
Magnesium sulphate is excreted in the urine by the kidneys. No need to measure magnesium levels as long as there is normal urine output. If women oliguric or has renal impairment, the kidney's won't excrete magnesium and the levels are likely to become toxic. (Prompt 2017)
40
Magnesium sulphate emergency protocol
``` Stop magnesium sulphate Basic life support Give 1g calcium gluconate IV Intubate early and ventilate until respiration resumes (Prompt 2017) ```
41
Fist line anti-hypertensive drug
Labetalol | Mayes 2012
42
Initial dose of labetalol
200mg orally | Mayes 2012
43
What does labetalol do?
Reduces peripheral resistance and cardiac output, thereby reducing blood pressure (Mayes 2012)
44
After the initial dose of labetalol, what to do if BP not below threshold after 30 minutes?
Repeat 200mg oral dose | Mayes 2012
45
After second dose of labetalol, BP rechecked after 30 minutes and still not below threshold
``` IV labetalol (5mg/ml) Loading: 10ml (50mg) over 2 minutes. Repeat after 5 minutes (max 4 doses) until BP controlled Maintenance: Start infusion at 4ml/hour. Double infusion rate every 30 minutes until BP controlled. Max infusion rate 32 ml/hour (Prompt 2017) ```
46
Who can't have labetalol?
Asthmatic and/or Afro-Caribbean | Prompt 2017
47
What is the second line drug for either women who can't have labetalol or another option after two doses of labetalol?
Nifedipine | Prompt 2017
48
Nifedipine dose
10mg orally | Mayes 2012
49
What does nifedipine do?
Is a calcium antagonist and lowers blood pressure by inhibiting calcium ion activity in the smooth muscle of the blood vessels, resulting in decreased peripheral vascular resistance (Mayes 2012)
50
After the first dose of nifedipine, if BP still above threshold after 30 minutes what can be given?
Second 10mg oral dose nifedipine | Prompt 2017
51
Third line drug of choice
Hydralazine | Mayes 2012
52
Hydralazine loading dose
5ml (5mg) over 15 minutes IV | Prompt 2017
53
Hydralazine maintenance dose
Start infusion at 5ml/hour. Titrate to systolic BP 140-150 mmHg Usual rate 2-3 mL/hour Max infusion rate 18ml/hour Reduce rate if significant adverse effect or maternal pulse >120 bpm (Prompt 2017)
54
Offering early birth for women with chronic hypertension
Do not offer birth to women with chronic hypertension whose blood pressure is lower than 160/110 mmHg, with or without antihypertensive treatment, before 37 weeks (NICE 2011b)

Midwifery Emergencies (11 decks)

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