Antenatal Care Flashcards
pre-eclampsia
high blood pressure in pregnancy and end organ dysfunction
- proteinuria
- hypertension
- oedema
- 20 weeks after gestation
- spiral arteries of the placenta form abnormally long which leads to high vascular resistance int he vessels
chronic hypertension
pregnancy induced HTN
pre-eclampsia
eclampsia
Chronic hypertension is high blood pressure that exists before 20 weeks gestation and is longstanding. This is not caused by dysfunction in the placenta and is not classed as pre-eclampsia.
Pregnancy-induced hypertension or gestational hypertension is hypertension occurring after 20 weeks gestation, without proteinuria.
Pre-eclampsia is pregnancy-induced hypertension associated with organ damage, notably proteinuria.
Eclampsia is when seizures occur as a result of pre-eclampsia.
pre eclampsia risk factors
high: Pre-existing hypertension Previous hypertension in pregnancy Existing autoimmune conditions (e.g. systemic lupus erythematosus) Diabetes Chronic kidney disease
moderate: Older than 40 BMI > 35 More than 10 years since previous pregnancy Multiple pregnancy First pregnancy Family history of pre-eclampsia
pre eclampsia symptoms
Headache Visual disturbance or blurriness Nausea and vomiting Upper abdominal or epigastric pain (this is due to liver swelling) Oedema Reduced urine output Brisk reflexes
systolic BP >140mmHg
diastolic BP >90mmHg
Proteinuria (1+ or more on urine dipstick)
urine protein:creatinine ratio >30mg
urine albumin:creatinine ratio >8mg
Organ dysfunction (e.g. raised creatinine, elevated liver enzymes, seizures, thrombocytopenia or haemolytic anaemia)
Placental dysfunction (e.g. fetal growth restriction or abnormal Doppler studies)
PIGF
placental growth factor
to test on one occasion during pregnancy in women suspected of having pre-eclampsia. low in pre-eclampsia.
pre-eclampsia management
prophylactic aspirin from 12 weeks gestation until birth with women who have 1 high risk factor or >2 moderate risk factors.
routine monitoring:
Blood pressure
Symptoms
Urine dipstick for proteinuria
management of gestational HTN
BP <135/85mmHg admit women with BP >160/11mmHg urine dipstick weekly monitor blood test weekly (FBC, LFT, renal) monitor fetal growth serial growth scans PIGF
pre-eclampsia mx
Scoring systems are used to determine whether to admit the woman (fullPIERS or PREP‑S)
Blood pressure is monitored closely (at least every 48 hours)
Urine dipstick testing is not routinely necessary (the diagnosis is already made)
Ultrasound monitoring of the fetus, amniotic fluid and dopplers is performed two weekly
Labetolol is first-line as an antihypertensive
Nifedipine (modified-release) is commonly used second-line
Methyldopa is used third-line (needs to be stopped within two days of birth)
Intravenous hydralazine may be used as an antihypertensive in critical care in severe pre-eclampsia or eclampsia
IV magnesium sulphate is given during labour and in the 24 hours afterwards to prevent seizures
Fluid restriction is used during labour in severe pre-eclampsia or eclampsia, to avoid fluid overload
- planned early birth if BP cannot be controlled
- corticosteroid for fetal llungs to mature
medical treatment of pre-eclampsia post-delivery
Enalapril (first-line)
Nifedipine or amlodipine (first-line in black African or Caribbean patients)
Labetolol or atenolol (third-line)
what is eclampsia?
seizures associated with pre-eclampsia
mx: IV magnesium sulphate
HELLP syndrome
a combination of features that occurs as a complication of pre-eclampsia and eclampsia. It is an acronym for the key characteristics:
Haemolysis
Elevated Liver enzymes
Low Platelets
gestational diabetes
diabetes triggered by pregnancy. reduced insulin sensitivity.
complications:
macrosomia
risk of shoulder dystocia
risk of developing type II DM
gestational diabetes screening
anyone with risk factors should be screened for an oral glucose tolerance test at 24-28 weeks.
women with previous GD should have an OGTT soon after booking clinic.
risk factors:
Previous gestational diabetes
Previous macrosomic baby (≥ 4.5kg)
BMI > 30
Ethnic origin (black Caribbean, Middle Eastern and South Asian)
Family history of diabetes (first-degree relative)
OGTT
oral glucose tolerance test
morning after fasting
drink 75g glucose
mesure blood sugar before and at 2 hours.
Normal results are:
Fasting: < 5.6 mmol/l
At 2 hours: < 7.8 mmol/l
Results higher than these values are used to diagnose gestational diabetes.
(5 6 7 8)
mx of gestational diabetes
four weekly ultrasound scan to monitor fetal growth and amniotic fluid volume from 28-36 weeks gestatin.
Fasting glucose less than 7 mmol/l: trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin
Fasting glucose above 7 mmol/l: start insulin ± metformin
Fasting glucose above 6 mmol/l plus macrosomia (or other complications): start insulin ± metformin
*glibenclamide (slufonylurea) for women who decline insulin and cannot tolerate metofrmin
monitor BM every day Fasting: 5.3 mmol/l 1 hour post-meal: 7.8 mmol/l 2 hours post-meal: 6.4 mmol/l Avoiding levels of 4 mmol/l or below
