7.5. Complications of Pregnancy - Hypertensive Disorders Flashcards
What is Chronic Hypertension?
Hypertension either:
- Pre-Pregnancy
- At Booking (<20 Weeks Gestation)
What are the Different Classificatiosn of Chronic Hypertension?
- Mild Hypertension
- Moderate Hypertension
- Severe Hypertension
What is Mild Chronic Hypertension?
- Diastolic Blood Pressure of 90-99
2. Systolic Blood Pressure of 140-149
What is Moderate Chronic Hypertension?
- Diastolic Blood Pressure of 100-109
2. Systolic Blood Pressure of 150-159
What is Severe Chronic Hypertension?
- Diastolic Blood Pressure of >110
2. Systolic Blood Pressure of >160
What is Gestational Hypertension also known as?
Pregnancy Induced Hypertension
What is Gestational Hypertension (Pregnancy Induced Hypertension)?
New Hypertension which develops after 20 weeks of Pregnancy
What is Pre-Eclampsia?
New Hypertension which develops after 20 weeks of Pregnancy, in association with Significant Proteinuria:
- Mild Hypertension on 2 occasions, > 4 hours apart
- Moderate Hypertension
- Severe Hypertension
+
Significant Proteinuria (>300mg/day)
How is Significant Proteinuria (In Pre-Eclampsia) Defined?
- Automated Reagent Strip Urine Protein Estimation > 1+
- Spot Urinary Protein : Creatinine Ratio >30mg/mmol
- 24 Hours Urine Protein Collection > 300mg/day
What should happen in Pre-Pregnancy Care, for Mothers with Chronic Hypertension?
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
What should be monitored for, in Mothers with Chronic Hypertension?
- Monitor Foetal Growth if on Beta-Blockers
2. Monitor for Superimposed Pre-Eclampsia
What is the Pathophysiology of Pre-Eclampsia?
- Immunological / Genetic Predisposition
- Secondary invasion of Maternal Spiral Arterioles by Trophoblasts Impaired
- Reduced Placental Perfusion
- Imbalance between Vasodilators / Vasoconstrictors in Pregnancy)
What are the Risk Factors for Developing Pre-Eclampsia?
- First Pregnancy / Pregnancy Interval > 10 years
- Extremes of Maternal Age
- Family History / Pre-Eclampsia in Previous Pregnancy
- BMI > 35
- Multiple Pregnancy
- Underlying Medical Disorders:
- a) Chronic Hypertension
- b) Pre-Existing Renal Disease
- c) Pre-Existing Diabetes
- d) Autoimmune Disorders
What does Pre-Eclampsia effect?
Multi-System, Multi-Organ Disorder:
- Renal
- Liver
- Vascular
- Cerebral
- Pulmonary
What are the Maternal Complications of Pre-Eclampsia?
- Eclampsia - Seizures
- Severe Hypertension - Cerebral Haemorrhage / Stroke
- HELLP - Haemolysis, Elevated Liver enzymes, Low Platelets
- Disseminated Intravascular Coagulation
- Renal Failure
- Pulmonary Oedema
- Cardiac Failure
What are the Foetal Complications of Pre-Eclampsia?
Impaired Placental Perfusion:
- Intrauterine Growth Restriction
- Foetal Distress
- Prematurity
- Increased Prenatal Mortality
What are the Signs / Symptoms of Severe Pre-Eclampsia?
- Headache / Papillodema / Blurring of Vision / Vomiting / Seizures (Eclampsia)
- Pain / Tenderness - Epigastric / Below Ribs
- Sudden Swelling of Hands / Face / Legs
- Severe Hypertension
- Clonus / Brisk Reflexes
- Reduced Urine Output - > 3+ of Proteinuria
What are the Biochemical Abnormalities which occur in Pre-Eclampsia?
- Raised Liver Enzymes - Bilirubin if HELLP present
- Raised Urea and Creatinine - Raised URate
Note - HELLP = Haemolysis, Elevated Liver enzymes, Low Platelets
What are the Haematological Abnormalities which occur in Pre-Eclampsia?
- Low Platelets
- Low Haemoglobin - Sign of Haemolysis
- Features of Disseminated Intravascular Coagulation
What is the Should be frequently checked for in the management of Pre-Eclampsia?
- Check Symptomatically - Headache / Blurred Vision etc.
- Check for Hyper-Reflexia (Clonus)
- Check for Tenderness over the Liver
- Frequent Blood Pressure / Urine Protein checks
What Blood investigations should take place in Pre-Eclampsia?
- Full Blood Count - Haemolysis / Platelets
- Liver Function Tests
- Renal Function Tests - Serum Urea / Creatinine / Urate
- Coagulation Test
What Foetal Investiagtions should take place in Pre-Eclampsia?
- Scan for Growth
2. Cardiotocography (CTG)
What is the only “Cure” for Pre-Eclampsia?
Delivery of the Baby and Placenta
What is the Conservative Management of Pre-Eclampsia?
- Close Observation of Clinical Signs / Investigations
- Anti-Hypertensives (Labetolol, Methyldopa, Nifedipine)
- Steroids for Foetal Lung Maturity
- Consider Induction of Labour / C-Section if Maternal / Foetal deterioration occurs
When does the risk of Pre-Eclampsia stop?
The Risk of Pre-Eclampsia extends into the Peuperium, so monitoring must be continued Post-Delivery
What percentage of Women have
- Pre-Eclampsia?
- Severe Pre-Eclampsia?
- Eclamptic Seizures?
- 5-8%
- 0.5%
- 0.05%
- a) 38% of Seizures occur in Antepartum
- b) 18% of Seizures occur Intrapartum
- c) 44% of Seizures occur Postpartum
What is the Treatment of Eclamptic Seizures?
- Magnesium Sulphate Bolus + I.V. Infusion
- Control of Blood Pressure - I.V. Labetolol, Hydrallazine (if > 160/110_
- Avoid Fluid Overload - Aim for 80mls / Hour Fluid intake
What Prophylactic Measures for Pre-Eclampsia are taken in subsequent pregnancies?
Low Dose Aspirin from 12 weeks till delivery