4: Hypertension in pregnancy Flashcards
Hypertension can ___ by pregnancy.
induced
due to cardiovascular changes in mother
What is the spectrum of disorders caused by hypertension in pregnancy?
Pregnancy-induced hypertension > Pre-eclampsia > Eclampsia
What is the fatal end-point of uncontrolled hypertension in pregnant women?
Eclampsia
What percentage of pregnant women suffer from hypertension?
10 - 15%
What cardiovascular changes occur in pregnancy?
HR, SV, contractility and CO INCREASE
BP and TPR DECREASE
How does blood pressure change during the course of pregnancy?
Initially drops
Then increases gradually until term
Same pattern post-birth
What blood pressure reading is required to diagnose a pregnant woman with hypertension?
> 140 / 90 on two occasions
> 160 / 110 once
In which trimester does pregnancy-induced hypertension tend to develop?
2nd trimester
If a pregnant woman develops hypertension before the 2nd trimester, what should you suspect?
Pre-existing hypertension
What is the course of pregnancy-induced hypertension?
Persists throughout pregnancy, then resolves 6 weeks post-birth
Does pregnancy-induced hypertension feature any other symptoms as in pre-eclampsia?
No
What is the triad of signs seen in pre-eclampsia?
Hypertension
Proteinuria
Oedema
What is pre-eclampsia?
A multi-system disorder developing in pregnant women and their foetuses due to widespread epithelial dysfunction
Presents as hypertension, proteinuria and oedema
In which trimester of pregnancy does pre-eclampsia present?
2nd trimester
What is the pathogenesis of pre-eclampsia?
Spiral arteries of placenta become compressed
Blood flow through tight arteries causes epithelial damage
Thrombosis –> Placental ischaemia
Toxins circulate throughout the body, causing widespread organ dysfunction
Which process is blocked in pre-eclampsia, causing widespread damage?
Angiogenesis
Why are toxins released from the placenta in pre-eclampsia?
Compression of spiral arteries causes endothelial damage, thrombosis and placenta ischaemia
The toxins released by the placenta in pre-eclampsia damage the ___ of other systems.
vasculature
What effects does pre-eclampsia have on the renal system?
Proteinuria
Reduced renal function (manifesting as decreased eGFR and urine output)
What effect does eclampsia (untreated pre-eclampsia) have on the CNS?
Seizures
Cerebral oedema
Cranial nerve palsy
Coma
What is a rare variant of pre-eclampsia caused by liver dysfunction?
HELLP syndrome
haemolysis, elevated liver enzymes, low platelets
HELLP syndrome is a variant of pre-eclampsia caused by damage to which organ?
What are the signs?
Liver
Haemolysis, elevated liver enzymes, low platelets
Where is pain felt in liver disease?
Epigastric region
Right upper quadrant
can refer to the right shoulder
What are some respiratory complications of pre-eclampsia?
Pulmonary oedema
Pulmonary embolism
The signs of pre-eclampsia are hypertension, proteinuria and oedema.
What are the symptoms?
Headache
Visual disturbance
Abdominal pain
N&V
Oedema
The foetus of a mother with untreated pre-eclampsia will be (small / large) for dates.
small for dates
Does eclampsia present with upper or lower motor neuron signs?
What are they?
UMN signs
Hyperreflexia, clonus
Followed by seizures and death
Keeping in mind the organs which are damaged by pre-eclampsia, what investigations would you do for it?
BP
Renal function - U&Es, eGFR, creatinine
Liver function tests
Foetal - ultrasound, CTG
What specific ultrasound scan can be done for pre-eclampsia?
Uterine artery doppler
Low flow and high resistance are signs of pre-eclampsia
What is the only definitive treatment for pre-eclampsia?
Delivery
If a baby has to be born pre-term, which drugs is the mother given to maximise chances of survival?
Steroids - speed up lung development
Magnesium - neuroprotective
In women with known pre-eclampsia, what is monitored at antenatal clinic visits?
BP
Renal function
Which drug is given in low doses to pregnant women with pre-eclampsia?
Why?
Aspirin
Prevention of thrombotic events
If women fulfill the risk factors for pre-eclampsia before pregnancy, which drug should they be given?
Low dose aspirin
Which antihypertensive drugs are pregnant women given in severe pre-eclampsia?
Methyldopa
Labetalol
Nifedipine
Which drug classes, normally prescribed for hypertension, must be avoided in pregnancy?
ACE inhibitors
Diuretics
both cause adverse effects on foetus
Name three antihypertensives prescribed for pre-eclampsia.
Methyldopa
Labetalol
Nifedipine
What type of seizures are seen in pre-eclampsia?
Tonic-clonic seizures
How is blood pressure controlled in eclampsia?
IV antihypertensives
so labetalol or hydralazine
Which drug is used to prevent or terminate seizures in eclampsia?
Magnesium sulphate
What side effect of spinal or epidural anaesthesia is useful in patients with eclampsia?
Widespread vasodilatation –> Hypotension
Which mode of delivery is preferred in women with (pre)eclampsia?
Vaginal delivery
