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7006PHM Prof Pharm II > Hypertensive Disorders of Preg > Flashcards

Hypertensive Disorders of Preg Flashcards

1
Q

What defines hypertension in pregnancy?

A

Systolic BP =/> 140 mmHg and/or
Diastolic BP =/> 90 mmHg

BP usually falls in pregnancy

25% of women who develop HTN = eventual diagnosis w/ pre-eclampsia

Chronic HTN = monitor every 2 weeks until 30 wks, then weekly till delivery

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2
Q

What is the maternal risk of untreated HTN in pregnancy?

A

Accelerated HTN, esp in 3rd tri

superimposed pre-eclampsia

maternal morbidity

Inc life-time CV risk

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3
Q

What is the foetal risk of untreated HTN in pregnancy?

A

Intrauterine growth restriction

Foetal death

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4
Q

Outline the classification of HTN in pregnancy

A

Chronic HTN = present/detected <20 wks

Gestational HTN = new onset HTN, >20wks, no additional pre-eclampsia

Pre-eclampsia-eclampsia = new onset HTN >20 wks, + systemic symptoms

Pre-eclampsia superimposed on chronic HTN = new onset of proteinuria, sudden worsening of HTN or proteinuria >20 wks

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5
Q

Explain mild chronic HTN in pregnancy (characteristics)

A

No evidence of end organ damage

W/draw HTN in 1st trimester, dec ADRs on foetus

Physiological fall in BP

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6
Q

Outline treatment moderate-severe chronic HTN in preg

A

Continue anti-HTN therapy

Change to appropriate anti-HTN

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7
Q

What is gestational HTN?

A

New onset HTN after 20 weeks, adverse preg outcomes

Normalisation of BP w/in 2 months

Risk of recurrence in subsequent preg

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8
Q

What is the target (BP) goal for gestational HTN?

A

Systolic reduction to = 140-160 mmHg

Diastolic reduction = 90-100mmHg

Stricter BP control = foetal growth restriction –> placental hypoperfusion

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9
Q

What HTN drugs should be avoided in gestational HTN?

A

ACEi = teratogenic in 1st tri

ARB = teratogenic in 1st tri

Diuretics = avoid

Beta blockers = avoid

CCB = avoid

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10
Q

What HTN drugs are safe in gestational HTN?

A

Labetalol

Oxprenolol

Methyldopa

Hydralazine = usually added to prazosin if therapy inadequate

Prazosin

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11
Q

What are the 1st line anti-HTN for gestational hypertension?

A

Methyldopa

Labetalol

oxprenalol

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12
Q

What are the 2nd line anti-HTN for gestational hypertension?

A

hydralazine

nifedipine

prazosin

clonidine

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13
Q

How is gestational HTN managed after 20 wks?

A

Same as <20wks

Add hydralazine if BP not controlled OR controlled release nifedipine

Close monitoring, 25% progress to pre-eclampsia

gestational HTN should resolve w/in 3 months PP, patient weaned off drugs

Monitor for pre-eclampsia = worsening HTN, new/worsening proteinuria

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14
Q

What is pre-eclampsia? (define, aetiology

A

Multi-system disorders characterised by one or more organ systems and/or foetus

Aetiology:
- immunological factors
- genetic factors
- placental factors = abnormal placental formation, release of systemic vasoactive compounds
- maternal vascular disease
- diet

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15
Q

*Outline risk factors of pre-eclampsia

A

Antiphospholipid syndrome

Pre-existing pre-eclampsia/diabetes, DM, nulliparity, multiple pregnancies

Renal disease, chronic HTN

Chronic autoimmune disease

<18 yrs of age, >40 yrs of age

> 10 yrs since last preg

BP >130/80 mmHg

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16
Q

*What are features of pre-eclampsia

A

Proteinuria = protein:creatinine ration >30g/mol

Renal = serum or plasma creatinine >90 micromol or oliguria

haematological = haemolysis, thrombocytopenia, raised bilirubin, dec haptglobulin

Hepatic = raise serum transaminases, severe upper right quadrant pain, epigastric pain

pulmonary oedema

uteroplacental = foetal growth restriction, placental abruption

neurological = severe headache, visual disturbances, hyperreflexia, convulsions, stroke

17
Q

Outline some symptoms/referral points of suspected of pre-eclampsia

A

Elevated BP, severe headache

Excessive N/V, vomiting blood, swelling of feet and hands

smaller amounts/no urine or blood in urine

rapid heart beat, dizziness, ringing/buzzing in ears

double/blurred vision

drowsiness, abdominal pain

18
Q

What are maternal complications of pre-eclampsia?

A

HELLP syndrome

placental abruption

acute renal failure

liver rupture

intracerebral haemorrhage

eclampsia

inc. risk of CVD

19
Q

What is HELLP syndrome?

A

Haemolysis, Elevated liver enzymes, Low Platelet count

Minimal BP elevation and renal dysfunction. exhibit severe liver disease

Life-threatening

20
Q

What are the early sx of HELLP?

A

epigastric pain (heartburn) or upper right quadrant pain

malaise

N/V

21
Q

What is eclampsia? (warning signs/sx, what is)

A

Complication of preg-induced HTN = new-onset seizures (early preg, early PP -24 hrs)

Warning signs/SX:
- headache, visual disturbances, epigastric pain, HTN, proteinuria
- unpredictable seizures

22
Q

What are foetal complications of pre-eclampsia?

A

Ischaemic encephalopathy

Intrauterine growth restriction

foetal death, due to placental insufficiency

23
Q

What are neonatal complications of pre-eclampsia?

A

preterm birth plus hypoxic and neurological injury

perinatal death

24
Q

What are complications of children born from pre-eclampsia?

A

Inc risk of stroke, CHD, metabolic syndrome

possible autism link, developmental delay

25
Q

How is mild pre-eclampsia managed?

A

monitored in outpatient setting

26
Q

How is moderate pre-eclampsia managed?

A

admission to antenatal ward w/ planned induction at 37 wks

27
Q

How is severe pre-eclampsia managed?

A

requires delivery, regardless of gestation

28
Q

Outline the pharmacological treatment of pre-eclampsia

A

anti-HTN = hydralazine, nifedipine, labetolol, or diazoxide) –> monitoring, IV fluids to prevent hypotension

IV magnesium sulfate = seizure prevention –> block glutamate receptor, prevent post-hypoxic brain injury

29
Q

Outline the postpartum management of pre-eclampsia

A

Resolved after birth, monitor 4 hrly = pulse, BP, RR, temp, O2

Avoid NSAIDs = effect HTN, renal function, platelet function

BP and urinalysis = normal by 6wk PP

30
Q

Outline pre-eclampsia prophylaxis

A

Primary prevention based on risk factor

Aspirin = from 12 wks onward for high risk patient, reduce stillbirth, neonatal, foetal death

Calcium = women of moderate to high risk of pre-eclampsia, if dietary intake low –> reduce risk

7006PHM Prof Pharm II (24 decks)

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