6 Hypertension in Pregnancy Flashcards
List the 5 Hypertensions in pregnancy
- Chronic or Essential hypertension
- Gestational hypertension
- Pre eclampsia
- Eclampsia
- HELLP Syndrome
Chronic or essential is when there is high blood pressure discovered _____ to the pregnancy. Meaning that the pregnancy itself is not the cause.
prior
The high blood pressure is found within the first ___ weeks of pregnancy.
20
Secondary causes of the high BP include (3)
- Renal disease
- Endocrine disorders
- Neurologic disorders
What hypertension occurs after 20 weeks?
Gestational Hypertension
Gestational hypertension is when the blood pressure is greater than __ occasions during pregnancy within __ hours of each other.
140/90 mmhg; 2; 6
gestational hypertension high blood pressure is found after the ___ week mark. The patient did not exhibit high BP before this mark.
20
With this type of hypertension there is no presence of protein in the urine and patients can be?
asymptomatic
Often gestational hypertension resolves within the first ___weeks of giving birth
12 weeks.
Patients with Gestational hypertension may have had high BP prior to the pregnancy and it may lead to
pre-eclampsia
Pre-eclampsia is though to be caused by
Prostaglandin abnormalities
Prostaglandins are a hormone like substance that participate in the following functions
Contraction and relaxation of smooth muscle
The dilation and constriction of blood vessels
control of blood pressure
modulation of inflammation
Pe-eclampsia occurs when there is an abnormal development of
blood vessels of the placenta in early pregnancy
With Pre-eclampsia oxygen supply to the fetus is?
reduced
In pre-eclampsia the spiral arteries remain rigid instead of becoming large and
tortuous
Pre-eclampsia occurs after __ weeks
20
What is the cause of pre-eclampsia ?
the placenta
When there is a decrease in oxygen to the placenta it releases inflamed molecules into the mothers blood stream and damages the
endothelial cells
The S & S of pre-eclampsia include (4)
- high BP 140/90mmHg after 20 week mark
- Protenuria
- Edema -swelling in the feet, hans and face
- rapid weight gain
In order for pre-eclampsia to be diagnosed
high blood pressure must be present with one of the other S&S.
HELLP Syndrome stands for ?
Hemolysis - (destruction of red blood cells)
Elevated Liver enzymes - (ongoing liver damage)
Low Platelets - (help blood clot)
A severe varient of pre-eclampsia
Abdominal pain due to hepatic hemorrhage
Eclampsia occurs in women with severe
Pre-eclampsia
Eclampsia is diagnosed when a women with pre-eclampsia has
seizures
Aprox 30-50% of patients with pre-eclampsia also have the ___Syndrome
HELLP Syndrome
Sonography in hypertension results in?
impaired circulation to the placenta
Impaired circulation in the placenta results in (7)
IUGR Preterm labour Placental abruption Placental infarcts Oligohydramnios Decreased placental maturation Fetal demise
What marker if low is considered a MARKER FOR PRE-ECLAMPSIA ?
PAPP A
A maternal blood test is performed at the first trimester screen in conjunction with the
Nuchal translucency
A repeat ultrasound is performed at ___ weeks with ____
23-24 weeks ;Doppler
Artery Doppler is performed to look for (2)
- Notching
2. low diastolic blood
Protocol for hypertension in pregnancy
- BPP (for fetal well-being)
- Growth (2nd or 3rd, Biometery)
- Doppler of the umbilical artery
Doppler - The umbilical artery normally is
LOW resistance
Abnormal umbilical artery is High resistance artery is
Low or reversed diastolic flow
What is the preferred method of measurement with umbilical artery doppler
Pulsatility index (PI)
When there is restriction to placental blood flow a loss of _______ frequency occurs or it is reversed
end-diastolic
THE MCA normally is
high resistance
Low resistance has an increased _____ flow
diastolic
When the MCA has impedence to blood flow the placenta has
low resistance
When there is placental insufficiency the fetus adapts by
vasodilation
With Hypoxia _____vasodilation occurs and once
cerebral
Once vasodialtion from hypoxia is exhausted the diastolic flow will start to
increase
The ______ can also be used as a screening tool
ductus venous
The ductus venosus is the main vessel which ____ blood returning from the placenta is directed to the ____ and ____
oxygenated ; fetal heart and circulation
In a normal fetus the ductus venosus demonstrates what appearance?
triphasic
With worsening fetal hypoxia there is a redistribution of high oxygenated umbilical vein blood through the ductus venosus to the fetal heart . when critical an ____ in ____ and during atrial contraction there is ______flow
increase; Peak systolic forward flow ; retrograde
Women with high risk of pre-eclampsia are screen using doppler indices for the _____
Uterine artery
Abnormal indices of the uterine artery result from?
increase resistance to flow
Often a ____ resistance waveform is associated with low change of pregnancy complications
low
high resistance waveform with ____ present at the end of systole and reduced end diastolic frequencies are associated with higher rate of pregnancy complications
notching
Notching in late pregnancy is an indicator of ?
increased uterine resistance and poor uterine circulation.
Treatment for Hypertension
- Bed rest
- Medication
- Monitoring mom and baby
What is the only was to reverse the process?
Delivery
Medication in pregnancy can cause (3)
fetal addition, IUGR and teratogenic defects
