5 - Obs - Hypertensive Disorders in Pregnancy - Pre-existing HTN in Pregnancy Flashcards
BP already ? or exceeds ?/? before ? weeks
- present in ?% of pregs
- more common in ? and ? women, women with +ve ? or who dev HTN taking ?
- preg-induced HTN > underlying ? to HTN and may need trt in ??
treated 140/90 20 5 older obese FHx COCP predisposition later life
Aetiology -
1’ or ? HTN is ? common cause. 2’ HTN commonly ass w ?, ? or renal disease eg ????, renal aa ? or chronic ? . Rare causes: phaeochromocytoma, Cushing’s, ? disease and ? of aorta.
idiopathic most obesity DM PCKD stenosis pyelonephritis cardiac coarctation
Clinical features - HTN ? in late preg. ? usually absent, although ? changes, ? bruits and ? delay should all be excluded in HTN
? with renal disease is normally present at ?
incr Sx fundal renal radiofemoral proteinuria booking
Complx - principal risks are ? HTN and ?, the risk for which is ? incr, other than these, perinatal ? is only marginally incr
worsening
preeclampsia
6x
mortality
Ix - To ID ? HTN:
-In ? cases, ? should be excluded w 2x 24h ?collections for ? acid (VMA). Worthwhile as ? mort of this is v ? .
- To look for ? disease: ?function assessed and renal ?
done.
- To ID pre-eclampsia: ? of any proteinuria at ? and a ?acid level allow for ? in later preg.
2' severe Pheochromocytoma (NE tumour, adrenal glands, secr adrenaline) urine vanillymandelic maternal high coexistent renal USS quantification booking uric comparison
MGMT -
HTN: Ideally, ? changed pre preg, ? are teratogenic and affect fetal ? prod. ? normally used, w ? a 2nd line agent. Meds may not be req in ? trim due to ? fall in BP.
meds ACEis urine labetalol nifedipine 2nd physiological
MGMT -
Risk of Pre-eclampsia: Preg trt as ? risk. ? w uterine aa ?
and additional ? visits is usual. Low-dose ? is advised. Pre-eclampsia suggested by ? HTN and confirmed by signif ? for first time after ?weeks.
Delivery: Usually undertaken by ? weeks, though benefits debated.
high screening doppler antenatal aspirin worsening proteinuria 20 40
