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Reproduction Week 4 2018/19 > 4: Hypertension in pregnancy > Flashcards

4: Hypertension in pregnancy Flashcards

1
Q

Hypertension can ___ by pregnancy.

A

induced

due to cardiovascular changes in mother

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2
Q

What is the spectrum of disorders caused by hypertension in pregnancy?

A

Pregnancy-induced hypertension > Pre-eclampsia > Eclampsia

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3
Q

What is the fatal end-point of uncontrolled hypertension in pregnant women?

A

Eclampsia

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4
Q

What percentage of pregnant women suffer from hypertension?

A

10 - 15%

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5
Q

What cardiovascular changes occur in pregnancy?

A

HR, SV, contractility and CO INCREASE

BP and TPR DECREASE

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6
Q

How does blood pressure change during the course of pregnancy?

A

Initially drops

Then increases gradually until term

Same pattern post-birth

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7
Q

What blood pressure reading is required to diagnose a pregnant woman with hypertension?

A

> 140 / 90 on two occasions

> 160 / 110 once

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8
Q

In which trimester does pregnancy-induced hypertension tend to develop?

A

2nd trimester

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9
Q

If a pregnant woman develops hypertension before the 2nd trimester, what should you suspect?

A

Pre-existing hypertension

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10
Q

What is the course of pregnancy-induced hypertension?

A

Persists throughout pregnancy, then resolves 6 weeks post-birth

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11
Q

Does pregnancy-induced hypertension feature any other symptoms as in pre-eclampsia?

A

No

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12
Q

What is the triad of signs seen in pre-eclampsia?

A

Hypertension

Proteinuria

Oedema

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13
Q

What is pre-eclampsia?

A

A multi-system disorder developing in pregnant women and their foetuses due to widespread epithelial dysfunction

Presents as hypertension, proteinuria and oedema

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14
Q

In which trimester of pregnancy does pre-eclampsia present?

A

2nd trimester

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15
Q

What is the pathogenesis of pre-eclampsia?

A

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

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16
Q

Which process is blocked in pre-eclampsia, causing widespread damage?

A

Angiogenesis

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17
Q

Why are toxins released from the placenta in pre-eclampsia?

A

Compression of spiral arteries causes endothelial damage, thrombosis and placenta ischaemia

18
Q

The toxins released by the placenta in pre-eclampsia damage the ___ of other systems.

A

vasculature

19
Q

What effects does pre-eclampsia have on the renal system?

A

Proteinuria

Reduced renal function (manifesting as decreased eGFR and urine output)

20
Q

What effect does eclampsia (untreated pre-eclampsia) have on the CNS?

A

Seizures

Cerebral oedema

Cranial nerve palsy

Coma

21
Q

What is a rare variant of pre-eclampsia caused by liver dysfunction?

A

HELLP syndrome

haemolysis, elevated liver enzymes, low platelets

22
Q

HELLP syndrome is a variant of pre-eclampsia caused by damage to which organ?

What are the signs?

A

Liver

Haemolysis, elevated liver enzymes, low platelets

23
Q

Where is pain felt in liver disease?

A

Epigastric region

Right upper quadrant

can refer to the right shoulder

24
Q

What are some respiratory complications of pre-eclampsia?

A

Pulmonary oedema

Pulmonary embolism

25
Q

The signs of pre-eclampsia are hypertension, proteinuria and oedema.

What are the symptoms?

A

Headache

Visual disturbance

Abdominal pain

N&V

Oedema

26
Q

The foetus of a mother with untreated pre-eclampsia will be (small / large) for dates.

A

small for dates

27
Q

Does eclampsia present with upper or lower motor neuron signs?

What are they?

A

UMN signs

Hyperreflexia, clonus

Followed by seizures and death

28
Q

Keeping in mind the organs which are damaged by pre-eclampsia, what investigations would you do for it?

A

BP

Renal function - U&Es, eGFR, creatinine

Liver function tests

Foetal - ultrasound, CTG

29
Q

What specific ultrasound scan can be done for pre-eclampsia?

A

Uterine artery doppler

Low flow and high resistance are signs of pre-eclampsia

30
Q

What is the only definitive treatment for pre-eclampsia?

A

Delivery

31
Q

If a baby has to be born pre-term, which drugs is the mother given to maximise chances of survival?

A

Steroids - speed up lung development

Magnesium - neuroprotective

32
Q

In women with known pre-eclampsia, what is monitored at antenatal clinic visits?

A

BP

Renal function

33
Q

Which drug is given in low doses to pregnant women with pre-eclampsia?

Why?

A

Aspirin

Prevention of thrombotic events

34
Q

If women fulfill the risk factors for pre-eclampsia before pregnancy, which drug should they be given?

A

Low dose aspirin

35
Q

Which antihypertensive drugs are pregnant women given in severe pre-eclampsia?

A

Methyldopa

Labetalol

Nifedipine

36
Q

Which drug classes, normally prescribed for hypertension, must be avoided in pregnancy?

A

ACE inhibitors

Diuretics

both cause adverse effects on foetus

37
Q

Name three antihypertensives prescribed for pre-eclampsia.

A

Methyldopa

Labetalol

Nifedipine

38
Q

What type of seizures are seen in pre-eclampsia?

A

Tonic-clonic seizures

39
Q

How is blood pressure controlled in eclampsia?

A

IV antihypertensives

so labetalol or hydralazine

40
Q

Which drug is used to prevent or terminate seizures in eclampsia?

A

Magnesium sulphate

41
Q

What side effect of spinal or epidural anaesthesia is useful in patients with eclampsia?

A

Widespread vasodilatation –> Hypotension

42
Q

Which mode of delivery is preferred in women with (pre)eclampsia?

A

Vaginal delivery

Reproduction Week 4 2018/19 (9 decks)

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