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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
How may pre-eclampsia present clinically
Varies: - Incidental finding on BP, Urinalysis - Epigastric pain - Frontal headaches - Visual changes - Oedema - Hyper-reflexia
26
How is pre-eclampsia divided
Mild, Moderate, Severe
27
What is mild pre-eclampsia
BP: 140-150 / 90-100
28
What is moderate pre-eclampsia
BP: 150-160 /100-110
29
What is severe pre-eclampsia
BP >160/110 with proteinuria >500mg in 24h | BP >140/90, proteinuria and symptoms
30
Explain pathophysiology of pre-eclampsia
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.
31
What may be given to prevent pre-eclampsia
Aspirin (75mg)
32
What are indications for prophylactic aspirin
One high-risk factor (P-CHAD) | Two moderate risk factors (BINFAM)
33
When is prophylactic aspirin started
12W
34
What is used to diagnose pre-eclampsia
BP, Urinalysis and then P:Cr or 24h Urine collection
35
What may FBC shown in pre-eclampsia
Anaemia | Thrombocytopenia
36
How may U+E present in pre-eclampsia
Raised Urea and Creatinine
37
How may LFTs present in pre-eclampsia
Raised ALT and AST
38
What should be used for VTE prophylaxis in pregnancy
Clexane (LMWH)
39
Why are anti-HTN given in pre-eclampsia
Prevent maternal stroke
40
What is first-line for pre-eclampsia
Labetalol
41
What are the indications for labetalol
BP > 160/110mmHg
42
What is second-line for pre-eclampsia
Nifedipine
43
What is the only definitive cure of pre-eclampsia
Delivery placenta
44
If women is less than 35W and planning to deliver what is required
Corticosteroids
45
When is delivery aimed for in pre-eclampsia
37W
46
What is third-line for pre-eclampsia
Methyldopa
47
What happens to pre-eclampsia following delivery and why
Monitor patient for 5d - as still risk of eclampsia (highest in 24h)
48
When are individuals considered no longer at risk of eclampsia
5d
49
What monitoring should happen post-natally
BP daily for two days and then every 2 days until day 5.
50
What are 4 foetal complications of pre-eclampsia
IUGR Intra-uterine death Placental abruption Pre-maturity
51
What is the main risk of pre-eclampsia
Eclampsia | Cerebral haemorrhage
52
What can pre-eclampsia increase risk of in the future
HTN | Pre-eclampsia or PIH in future pregnancies
53
What is a variant of pre-eclampsia
HELLP syndrome
54
What does HELLP syndrome stand for
Haemolysis Elevated Liver enzymes Low Platelets
55
What is the order of HELLP syndrome
Liver enzymes increase Platelets decrease Haemolysis
56
What are the symptoms of HELLP syndrome
Epigastric pain RUQ pain N+V Dark Urine
57
Why is urine dark in HELLP syndrome
Due to haemolysis
58
How is HELLP syndrome managed
Delivery
59
What is needed if C-section and platelets less than 50
Platelet transfusion
60
Define eclampsia
Seizures in pre-eclampsic women not caused by neurological or metabolic disturbance
61
What are moderate risk factors for eclampsia
``` BMI >30 Interval >10y Nulliparous FH Age >40 Multiple pregnancy ```
62
What are high risk factors for eclampsia
``` Previous Pre-Eclampsia CKD HTN Autoimmune Diabetes ```
63
How does eclampsia present clinically in mother
``` Generalised Tonic-Clonic Seizure Epigastric pain Headache Oedema Hyper-reflexia Visual disturbance ```
64
How will foetus present in eclampsia
Bradycardia
65
When do the majority of seizures occur in eclampsia
Post-Natal (40%) | Antepartum (35%)
66
What will FBC shown in eclampsia
Haemolysis - HELPP | Thrombocytopenia - HELPP
67
Why are coagulation studies ordered in eclampsia
Check for DIC complication
68
Why is capillary blood glucose ordered in eclampsia
Exclude other causes of seizures
69
Why may AUS be ordered in eclampsia
Check for placental abruption = complication pre-eclampsia
70
What monitoring should all women with eclampsia be put on
CTG
71
When is an CT indicated in pregnancy
Seizures in first-trimester or head trauma
72
How should eclampsia be approached
A-E
73
What position should women be put in
Left lateral and airway secured
74
What is given to treat seizures in eclampsia
Magnesium sulphate
75
What are two features of magnesium-sulphate OD
Hypo-reflexia | Resp depression
76
How is magnesium-sulphate OD treated
Calcium gluconate
77
When is magnesium sulphate given as prophylaxis
Symptoms pre-eclampsia
78
What dose of magnesium sulphate is given for seizures
4g in 100ml NaCl then 1g/24h maintenance
79
Alongside magnesium sulphate, what should be given in eclampsia
IV Anti-HTN | Labetalol or hydralazine
80
What anti-HTN are given
Labetalol | Hydralazine
81
What is only definitive management of eclampsia
Delivery
82
Explain delivery in eclampsia
Cannot deliver foetus until mother is stable - oxygen, no seizures
83
What is preferred method for delivery in eclampsia
C-section
84
Where is patient sent post-delivery
HDU

Obstetrics (27 decks)

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