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3rd Year - Reproductive Diseases > 7.5. Complications of Pregnancy - Hypertensive Disorders > Flashcards

7.5. Complications of Pregnancy - Hypertensive Disorders Flashcards

1
Q

What is Chronic Hypertension?

A

Hypertension either:

  1. Pre-Pregnancy
  2. At Booking (<20 Weeks Gestation)
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2
Q

What are the Different Classificatiosn of Chronic Hypertension?

A
  1. Mild Hypertension
  2. Moderate Hypertension
  3. Severe Hypertension
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3
Q

What is Mild Chronic Hypertension?

A
  1. Diastolic Blood Pressure of 90-99

2. Systolic Blood Pressure of 140-149

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4
Q

What is Moderate Chronic Hypertension?

A
  1. Diastolic Blood Pressure of 100-109

2. Systolic Blood Pressure of 150-159

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5
Q

What is Severe Chronic Hypertension?

A
  1. Diastolic Blood Pressure of >110

2. Systolic Blood Pressure of >160

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6
Q

What is Gestational Hypertension also known as?

A

Pregnancy Induced Hypertension

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7
Q

What is Gestational Hypertension (Pregnancy Induced Hypertension)?

A

New Hypertension which develops after 20 weeks of Pregnancy

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8
Q

What is Pre-Eclampsia?

A

New Hypertension which develops after 20 weeks of Pregnancy, in association with Significant Proteinuria:

  1. Mild Hypertension on 2 occasions, > 4 hours apart
  2. Moderate Hypertension
  3. Severe Hypertension
    +
    Significant Proteinuria (>300mg/day)
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9
Q

How is Significant Proteinuria (In Pre-Eclampsia) Defined?

A
  1. Automated Reagent Strip Urine Protein Estimation > 1+
  2. Spot Urinary Protein : Creatinine Ratio >30mg/mmol
  3. 24 Hours Urine Protein Collection > 300mg/day
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10
Q

What should happen in Pre-Pregnancy Care, for Mothers with Chronic Hypertension?

A 
Change Antihypertensive Medication (If Indicated):
1. Stop ACE Inhibitors
2. Stop Angiotensin Receptor Blockers
3. Stop Anti-Diuretic Medications
4. Lower Dietary Sodium
Note - Aim to keep the BP < 150/100
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11
Q

What should be monitored for, in Mothers with Chronic Hypertension?

A
  1. Monitor Foetal Growth if on Beta-Blockers

2. Monitor for Superimposed Pre-Eclampsia

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12
Q

What is the Pathophysiology of Pre-Eclampsia?

A
  1. Immunological / Genetic Predisposition
  2. Secondary invasion of Maternal Spiral Arterioles by Trophoblasts Impaired
  3. Reduced Placental Perfusion
  4. Imbalance between Vasodilators / Vasoconstrictors in Pregnancy)
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13
Q

What are the Risk Factors for Developing Pre-Eclampsia?

A
  1. First Pregnancy / Pregnancy Interval > 10 years
  2. Extremes of Maternal Age
  3. Family History / Pre-Eclampsia in Previous Pregnancy
  4. BMI > 35
  5. Multiple Pregnancy
  6. Underlying Medical Disorders:
  7. a) Chronic Hypertension
  8. b) Pre-Existing Renal Disease
  9. c) Pre-Existing Diabetes
  10. d) Autoimmune Disorders
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14
Q

What does Pre-Eclampsia effect?

A

Multi-System, Multi-Organ Disorder:

  1. Renal
  2. Liver
  3. Vascular
  4. Cerebral
  5. Pulmonary
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15
Q

What are the Maternal Complications of Pre-Eclampsia?

A
  1. Eclampsia - Seizures
  2. Severe Hypertension - Cerebral Haemorrhage / Stroke
  3. HELLP - Haemolysis, Elevated Liver enzymes, Low Platelets
  4. Disseminated Intravascular Coagulation
  5. Renal Failure
  6. Pulmonary Oedema
  7. Cardiac Failure
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16
Q

What are the Foetal Complications of Pre-Eclampsia?

A

Impaired Placental Perfusion:

  1. Intrauterine Growth Restriction
  2. Foetal Distress
  3. Prematurity
  4. Increased Prenatal Mortality
17
Q

What are the Signs / Symptoms of Severe Pre-Eclampsia?

A
  1. Headache / Papillodema / Blurring of Vision / Vomiting / Seizures (Eclampsia)
  2. Pain / Tenderness - Epigastric / Below Ribs
  3. Sudden Swelling of Hands / Face / Legs
  4. Severe Hypertension
  5. Clonus / Brisk Reflexes
  6. Reduced Urine Output - > 3+ of Proteinuria
18
Q

What are the Biochemical Abnormalities which occur in Pre-Eclampsia?

A
  1. Raised Liver Enzymes - Bilirubin if HELLP present
  2. Raised Urea and Creatinine - Raised URate
    Note - HELLP = Haemolysis, Elevated Liver enzymes, Low Platelets
19
Q

What are the Haematological Abnormalities which occur in Pre-Eclampsia?

A
  1. Low Platelets
  2. Low Haemoglobin - Sign of Haemolysis
  3. Features of Disseminated Intravascular Coagulation
20
Q

What is the Should be frequently checked for in the management of Pre-Eclampsia?

A
  1. Check Symptomatically - Headache / Blurred Vision etc.
  2. Check for Hyper-Reflexia (Clonus)
  3. Check for Tenderness over the Liver
  4. Frequent Blood Pressure / Urine Protein checks
21
Q

What Blood investigations should take place in Pre-Eclampsia?

A
  1. Full Blood Count - Haemolysis / Platelets
  2. Liver Function Tests
  3. Renal Function Tests - Serum Urea / Creatinine / Urate
  4. Coagulation Test
22
Q

What Foetal Investiagtions should take place in Pre-Eclampsia?

A
  1. Scan for Growth

2. Cardiotocography (CTG)

23
Q

What is the only “Cure” for Pre-Eclampsia?

A

Delivery of the Baby and Placenta

24
Q

What is the Conservative Management of Pre-Eclampsia?

A
  1. Close Observation of Clinical Signs / Investigations
  2. Anti-Hypertensives (Labetolol, Methyldopa, Nifedipine)
  3. Steroids for Foetal Lung Maturity
  4. Consider Induction of Labour / C-Section if Maternal / Foetal deterioration occurs
25
Q

When does the risk of Pre-Eclampsia stop?

A

The Risk of Pre-Eclampsia extends into the Peuperium, so monitoring must be continued Post-Delivery

26
Q

What percentage of Women have

  1. Pre-Eclampsia?
  2. Severe Pre-Eclampsia?
  3. Eclamptic Seizures?
A
  1. 5-8%
  2. 0.5%
  3. 0.05%
  4. a) 38% of Seizures occur in Antepartum
  5. b) 18% of Seizures occur Intrapartum
  6. c) 44% of Seizures occur Postpartum
27
Q

What is the Treatment of Eclamptic Seizures?

A
  1. Magnesium Sulphate Bolus + I.V. Infusion
  2. Control of Blood Pressure - I.V. Labetolol, Hydrallazine (if > 160/110_
  3. Avoid Fluid Overload - Aim for 80mls / Hour Fluid intake
28
Q

What Prophylactic Measures for Pre-Eclampsia are taken in subsequent pregnancies?

A

Low Dose Aspirin from 12 weeks till delivery

3rd Year - Reproductive Diseases (41 decks)

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