O&G Written - HTN disorders Flashcards
High risk factors for pre-eclampsia
Previous PET or HTN in pregnancy Chronic kidney disease T1 or T2DM AI disease - SLE, anti-phospholipid syndrome Chronic HTN
Moderate RF for pre-eclampsia
Primigravid Age 40+ Pregnancy interval >10 years BMI >35 Family Hx PET Multiple pregnancy
Indication for prophylactic aspirin
1 + high risk factor or 2+ moderate RF = aspirin 75mg OD from 12 weeks onward
Medical management of PET
1st line = Labetalol (CAUTION: asthma)
2nd line - Nifedipine
3rd line = Methyldopa (CAUTION: depression)
Medical management of PET
1st line = Labetalol (CAUTION: asthma)
2nd line - Nifedipine
3rd line = Methyldopa (CAUTION: depression)
Target BP in pregnancy
<135/85 mmHg
Monitoring required in mild-moderate PET
Outpatient care (usually)
BP every 48 hours
FBC, LFT, U&E + urinalysis twice per week
USS at diagnosis and every 2-4 weeks (unless abnormal)
Management of eclamptic fit
A-E approach
IV magnesium sulphate loading dose 4g over 5-15 mins
THEN 1g/hour infusion - continued until 24 hours after last fit
+/- steroids if <34 weeks gestation
+ DELIVER baby
Signs of magnesium sulphate toxicity
Loss of patellar reflexes
THEN
Respiratory depression
Hypotension
Indications for delivery in PET
<34 weeks = monitoring UNLESS indications for early birth
-if so, give steroids + Mag Sulphate if delivery likely
34-36 weeks = consider risk: benefit
- offer steroids + IV mag sulphate if delivery likely
37+ weeks: birth within 24-48 hours
Principles of intra-partum care in PET
Measure BP hourly (mild-mod) or every 15-30 mins (severe)
Continue anti-HTN meds
Do not pre-load with fluids before epidural
Avoid maternal pushing if BP reaches 160/110 in 2nd stage
- risks cerebral haemorrhage
- operative / assisted birth!
Do not give ergometrine for active management of 3rd stage / PPH Tx
Post-partum anti HTN medications If breastfeeding
1st line = Enalapril (or Nifedipine if Black African / Caribbean)
What to do with anti HTN meds after delivery? (in PET)
If on methyldopa, switch within 2 days after birth
Consider reducing med if BP <140/90
Definitely reduce med if BP <130/80
R/v with GP in 2 weeks post-discharge
Follow up tests needed in PET?
R/v with GP in 2 weeks (if taking anti HTN meds) or 6-8 weeks otherwise
Urinary reagent strip test (urie dip?)
- if proteinuria –> review kidney function at 3 months
If abnormal kidney function –> specialist assessment for CKD
Recurrence stats in PET
15-16% recurrence of PET
20% experience HTN
6-12% experience gestational HTN
2% experience chronic HTN
