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Obstetrics > Antenatal Care: HTN Disorders > Flashcards

Antenatal Care: HTN Disorders Flashcards

1
Q

Define pregnancy-induced hypertension

A

BP of >140/90mmHg developing after 20W

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2
Q

What should be checked if a women presents with pregnancy-induced HTN and why

A

Urinalysis and P:Cr to exclude pre-eclampsia

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3
Q

What is mild PIH

A

140-150 / 90-100

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4
Q

What is the management of mild PIH

A

Weekly BP

4W growth scans

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5
Q

What is moderate PIH

A

150-160 / 100-110

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6
Q

How is moderate PIH managed

A

Oral labetalol

Measure BP and Urinalysis - twice a week

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7
Q

What is severe PIH

A

> 160 / >110

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8
Q

How should severe PIH be managed

A

Admit
BP QDS
U+E, LFT, FBC

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9
Q

When should delivery be aimed for in PIH

A

37W

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10
Q

If unstable, what should happen

A

Prepare for delivery

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11
Q

Explain anti-HTN treatment post-delivery

A

Continue anti-HTN until BP <130/80

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12
Q

When should anti-HTN treatment be reduced

A

BP <130/80

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13
Q

When should anti-HTN treatment be reviewed

A

2 and 6W

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14
Q

If still requiring anti-HTN at 6W what should be done

A

Refer to specialist

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15
Q

What is a complication of pregnancy induced HTN

A

Increases risk of pre-eclampsia

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16
Q

What are the 3 criteria to diagnose someone with pre-eclampsia

A
  1. BP
    - >140/90mmHg on two occasions at least 4h apart
  2. Urinalysis
    - P:Cr > 30 mg/mmol
    - Protein more than 300mg in 24h
  3. > 20W gestation
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17
Q

What defines proteinuria

A

More than 300mg in 24h urine collection.

P:Cr - >30mg/mmol

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18
Q

How are risk factors for pre-eclampsia divided

A

High-risk and Moderate-risk

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19
Q

What is a mnemonic to remember ‘high-risk’ factors for pre-eclampsia

A

PCHAD

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20
Q

What are the ‘high-risk’ factors for pre-eclampsia

A 
Previous pre-eclampsia
CKD
HTN
Autoimmune: SLE, RA, Antiphospholipid syndrome
Diabetes
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21
Q

What is a mnemonic to remember moderate RF for pre-eclampsia

A

FAMBIN

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22
Q

What are the moderate-RF for pre-eclampsia

A 
FH
Age >40
Multiple pregnancy
BMI >30 
Interval >10y between pregnancies 
Nulliparous
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23
Q

What should be checked at every antenatal visit

A

BP and Urinalysis

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24
Q

How many antenatal visits does a nulliparous women have if uncomplicated

A

10

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25
Q

How may pre-eclampsia present clinically

A

Varies:

  • Incidental finding on BP, Urinalysis
  • Epigastric pain
  • Frontal headaches
  • Visual changes
  • Oedema
  • Hyper-reflexia
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26
Q

How is pre-eclampsia divided

A

Mild, Moderate, Severe

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27
Q

What is mild pre-eclampsia

A

BP: 140-150 / 90-100

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28
Q

What is moderate pre-eclampsia

A

BP: 150-160 /100-110

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29
Q

What is severe pre-eclampsia

A

BP >160/110 with proteinuria >500mg in 24h

BP >140/90, proteinuria and symptoms

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30
Q

Explain pathophysiology of pre-eclampsia

A

Abnormal placentation. Normally trophoblasts invade myometrium causing dilation spiral arteries - resulting in high-flow, low resistance circulation. In pre-eclampsia this changes to give a high-resistance, low flow circulation.

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31
Q

What may be given to prevent pre-eclampsia

A

Aspirin (75mg)

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32
Q

What are indications for prophylactic aspirin

A

One high-risk factor (P-CHAD)

Two moderate risk factors (BINFAM)

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33
Q

When is prophylactic aspirin started

A

12W

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34
Q

What is used to diagnose pre-eclampsia

A

BP, Urinalysis and then P:Cr or 24h Urine collection

35
Q

What may FBC shown in pre-eclampsia

A

Anaemia

Thrombocytopenia

36
Q

How may U+E present in pre-eclampsia

A

Raised Urea and Creatinine

37
Q

How may LFTs present in pre-eclampsia

A

Raised ALT and AST

38
Q

What should be used for VTE prophylaxis in pregnancy

A

Clexane (LMWH)

39
Q

Why are anti-HTN given in pre-eclampsia

A

Prevent maternal stroke

40
Q

What is first-line for pre-eclampsia

A

Labetalol

41
Q

What are the indications for labetalol

A

BP > 160/110mmHg

42
Q

What is second-line for pre-eclampsia

A

Nifedipine

43
Q

What is the only definitive cure of pre-eclampsia

A

Delivery placenta

44
Q

If women is less than 35W and planning to deliver what is required

A

Corticosteroids

45
Q

When is delivery aimed for in pre-eclampsia

A

37W

46
Q

What is third-line for pre-eclampsia

A

Methyldopa

47
Q

What happens to pre-eclampsia following delivery and why

A

Monitor patient for 5d - as still risk of eclampsia (highest in 24h)

48
Q

When are individuals considered no longer at risk of eclampsia

A

5d

49
Q

What monitoring should happen post-natally

A

BP daily for two days and then every 2 days until day 5.

50
Q

What are 4 foetal complications of pre-eclampsia

A

IUGR
Intra-uterine death
Placental abruption
Pre-maturity

51
Q

What is the main risk of pre-eclampsia

A

Eclampsia

Cerebral haemorrhage

52
Q

What can pre-eclampsia increase risk of in the future

A

HTN

Pre-eclampsia or PIH in future pregnancies

53
Q

What is a variant of pre-eclampsia

A

HELLP syndrome

54
Q

What does HELLP syndrome stand for

A

Haemolysis
Elevated Liver enzymes
Low Platelets

55
Q

What is the order of HELLP syndrome

A

Liver enzymes increase
Platelets decrease
Haemolysis

56
Q

What are the symptoms of HELLP syndrome

A

Epigastric pain
RUQ pain
N+V
Dark Urine

57
Q

Why is urine dark in HELLP syndrome

A

Due to haemolysis

58
Q

How is HELLP syndrome managed

A

Delivery

59
Q

What is needed if C-section and platelets less than 50

A

Platelet transfusion

60
Q

Define eclampsia

A

Seizures in pre-eclampsic women not caused by neurological or metabolic disturbance

61
Q

What are moderate risk factors for eclampsia

A 
BMI >30
Interval >10y
Nulliparous
FH
Age >40
Multiple pregnancy
62
Q

What are high risk factors for eclampsia

A 
Previous Pre-Eclampsia 
CKD
HTN
Autoimmune
Diabetes
63
Q

How does eclampsia present clinically in mother

A 
Generalised Tonic-Clonic Seizure 
Epigastric pain 
Headache 
Oedema 
Hyper-reflexia
Visual disturbance
64
Q

How will foetus present in eclampsia

A

Bradycardia

65
Q

When do the majority of seizures occur in eclampsia

A

Post-Natal (40%)

Antepartum (35%)

66
Q

What will FBC shown in eclampsia

A

Haemolysis - HELPP

Thrombocytopenia - HELPP

67
Q

Why are coagulation studies ordered in eclampsia

A

Check for DIC complication

68
Q

Why is capillary blood glucose ordered in eclampsia

A

Exclude other causes of seizures

69
Q

Why may AUS be ordered in eclampsia

A

Check for placental abruption = complication pre-eclampsia

70
Q

What monitoring should all women with eclampsia be put on

A

CTG

71
Q

When is an CT indicated in pregnancy

A

Seizures in first-trimester or head trauma

72
Q

How should eclampsia be approached

A

A-E

73
Q

What position should women be put in

A

Left lateral and airway secured

74
Q

What is given to treat seizures in eclampsia

A

Magnesium sulphate

75
Q

What are two features of magnesium-sulphate OD

A

Hypo-reflexia

Resp depression

76
Q

How is magnesium-sulphate OD treated

A

Calcium gluconate

77
Q

When is magnesium sulphate given as prophylaxis

A

Symptoms pre-eclampsia

78
Q

What dose of magnesium sulphate is given for seizures

A

4g in 100ml NaCl then 1g/24h maintenance

79
Q

Alongside magnesium sulphate, what should be given in eclampsia

A

IV Anti-HTN

Labetalol or hydralazine

80
Q

What anti-HTN are given

A

Labetalol

Hydralazine

81
Q

What is only definitive management of eclampsia

A

Delivery

82
Q

Explain delivery in eclampsia

A

Cannot deliver foetus until mother is stable - oxygen, no seizures

83
Q

What is preferred method for delivery in eclampsia

A

C-section

84
Q

Where is patient sent post-delivery

A

HDU

Obstetrics (27 decks)

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