Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Extra 5 (e) > Antenatal Problems 2 > Flashcards

Antenatal Problems 2 Flashcards

1
Q

How common is pregnancy induced hypertension (PIH)?

A

Affects 6-7% pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What happens to BP during the first 24 weeks of pregnancy?

A

BP decreases early in pregnancy until 24 weeks due to decrease in vascular resistance (due to progesterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens to BP in pregnancy after 24 weeks?

A

BP increases after 24 weeks until delivery due to an increase in stroke volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens to BP after delivery?

A

BP decreases after pregnancy but may peak again 3-4 days post-partum (post-partum HTN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is PIH?

A

> 140/90mmhg in the second half of pregnancy in the absence of proteinuria or other markers of pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are those with PIH at an increased risk of developing?

A

Pre-eclampsia

  • Increased risk with earlier onset of HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How many pregnancies does chronic HTN affect?

A

3-5% pre-date pregnancy = have high booking BP of 130-140/80-90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some secondary causes of HTN which may affect pregnancy?

A
  • Renal disease eg polycycstic disease, renal artery stenosis or chronic pyelonephritis
  • DM
  • Cardiac disease eg coarctation of the aorta
  • Endocrine disease eg Cushings, Conns or rarely pheochromocytoma

NB in post-partum HTN important to determine if it is physiological, pre-existing chronic or new onset pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some signs/symptoms of PIH?

A

Often asymptomatic

  • Fundal changes
  • Renal bruits
  • Radio-femoral delay
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some risks of PIH?

A
  • Pre-eclampsia
  • IUGR
  • Placental abruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In post-partum HTN, what are symptoms such as epigastric pain, visual disturbances or new onset proteinuria indicative of?

A

Post-partum pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What investigations should be done for PIH?

A
  • Urinalysis = look for protein
  • Bloods = FBC, U&Es, urate, LFTS, coagulation screen (normal if essential HTN in pregnancy)
  • USS
  • Investigate underlying cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the ddx of PIH?

A
  • Pre-eclampsia

- Secondary cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What anti-HTN are safe in pregnancy?

A

First line:

  • Methyldopa
  • Labetalol

Second line:

  • Nifedipine
  • Verapamil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MOVE CARD

A BP of what in pregnancy is a medical emergency?

A

> 160/110

If proteinuria develops = super-imposed pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which anti-HTN are contraindicated in pregnancy?

A

ACEi and angiotensin receptor blockers = teratogenic

Beta blockers (except labetalol and oxprenolol) and calcium channel blockers (except nifedipine) should be avoided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why may medication not usually required in PIH?

A

During the second trimester due to the physiological fall in NP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What drugs should be used postnatally for PIH?

A

Methyldopa should be changed due to the risk of postnatal depression:

  • Captopril up to 25mg PO TDS (beta blocker)
    OR
  • Nifedipine 10mg PO BD up to 30mg PO QDS

= breastfeeding safe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the postnatal management of PIH?

A

Under GP care

  • Women on medication should be offered postnatal follow up at 6 weeks
  • If BP raised after 6 months look for secondary causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Methyldopa:

  • Dose
  • SE
A

250mg BD up to 1g TDS

SE: depression - postnatally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Nifedipine:

  • Dose
  • SE
A

10mg BD up to 30mg TDS

SE: tachycardia, flushing, headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hydralazine:

  • Dose
  • SE
A

25mg TDS up to 75mg QDS

SE: tachycardia, pounding heartbeat, headache, diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Atenolol:

  • Dose
  • Avoid when?
A

50mg-100mg OD

Avoid in asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Oxprenolol

  • Dose
  • SE
  • Avoid when?
A

80mg TDS - 120mg TDS

  • May cause nightmares

Avoid in asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Labetalol

  • Dose
  • Avoid when?
A

100mg BD up to 600mg QDS

IV infusion for severe refractory HTN

Avoid in asthma

26
Q

ACEi = given when?

A

Postpartum only as fetotoxic

Captopril safe in breastfeeding

27
Q

How common is pre-eclampsia?

A

10% of pregnancies

Severe = 1%

28
Q

What is pre-eclampsia?

A

PIH in association with proteinuria (>0.3g in 24 hours) +/- oedema. Virtually any organ system may be affected

29
Q

What is the pathophysiology of pre-eclampsia?

A

Mechanism poorly understood but the placenta plays a pivotal role

Suboptimal uteroplacental perfusion associated with a maternal inflammatory response and maternal vascular endothelial dysfunction. This leads to vascular hypermermeabiltiy, thrombophilia and HTN, which may compensate for reduced flow in uterine arteries.

Increased vascular resistance = HTN
Increased vascular permeability = proteinuria
Reduced placental blood flow = IUGR and reduced cerebral perfusion

30
Q

What measurements indicate pre-eclampsia?

A

BP at or above 140/90mmHg AND at or above 300mg proteinuria in a 24hr collection

31
Q

What measurements indicate pre-eclampsia in an already hypertensive patient?

A

Rise in systolic BP of 30mmHg or more

or diastolic BP of 15mmHg or more

32
Q

How is mild/moderate/severe pre-eclampsia categorised?

A

Mild = proteinuria + BP <170/110mmHg

Moderate = proteinuria + BP greater than/equal to 170/1120mmHg

Severe = proteinuria + HTN before 32wks or with maternal complications

33
Q

What are some risk factors for pre-eclampsia? (10)

A
  • Previous pre-eclampsia
  • Previous severe/early pre-eclampsia
  • Age >40 or teenager
  • FH (mother/sister)
  • BMI >30
  • Primiparity
  • Twins
  • Fetal hydrops
  • Hyatidiform mole
  • Pre-existing medical conditions: HTN, DM, renal disease, antiphospholipid antibodies, thrombophilias, connective tissue disease
34
Q

What are some signs/symptoms of pre-eclampsia? (10)

A

Symptoms usually only occur with severe disease:

  • Headache (esp frontal)
  • Visual disturbances (esp flashing lights)
  • Epigastric / RUG pain = sign of liver involvement and liver capsule distension
  • N&V
  • Rapid oedema (esp face)
  • HTN
  • Proteinuria
  • Confusion / drowsiness
  • Hyperreflexia and/or clonus (>3 beats) = sign of cerebral irritability
  • Uterine tenderness / vaginal bleeding from a placental abruption
  • Fetal growth restriction on US (esp <36wks)
35
Q

What are some maternal complications of pre-eclampsia? (6)

A
  • Eclampsia = tonic-clonic seizures resulting from cerebrovascular vasospasm
  • Cerebral haemorrhage
  • Liver / renal failure
  • DIC
  • Pulmonary oedema
  • HELLP syndrome
36
Q

What is HELLP syndrome?

WRITE UP HELLP SYNDROME

A

Haemolysis
Elevated Liver enzymes
Low Platelet count

37
Q

What are some fetal complications of pre-eclampsia? (5)

A
  • IUGR
  • Morbidity and mortality
  • Placenta abruption
  • Pre-term birth
  • Hypoxia
38
Q

What would a FBC show in pre-eclampsia?

A
  • Thrombocytopenia = due to platelet aggregation on damaged endothelium indicated impending HELLP or DIC
  • Anaemia = if haemolysis
  • Relative high Hb due to haemoconcentration
39
Q

What would a clotting screen show in pre-eclampsia?

A

Prolonged PT and APTT

40
Q

What would biochemistry investigations show in pre-eclampsia?

A
  • Raised urate
  • Raised urea and creatinine
  • Abnormal LFTs = raised transamninases
  • Raised LDH = a marker for haemolysis
  • Urinalysis = proteinuria
41
Q

What is the cure of pre-eclampsia?

NB ? Magnesium sulphate is used for both treatment and prevention of eclampsia

XXXXXXXXXX

A

Delivery of the placenta

42
Q

When is out-patient management of pre-eclampsia appropriate? What is the management plan?

A
  • BP <160 systolic and <110 diastolic and can be controlled
  • No or low (<0.3g / 24hrs) proteinuria
  • Asymptomatic

NB: difficult to distinguish from gestational HTN

  • Warn about the development of symptoms
  • Review BP and urine every 1-2wks
  • Weekly review of blood biochemistry
43
Q

What is the management of mild-moderate pre-eclampsia, where BP <160 systolic and <110 diastolic with significant proteinuria and no maternal complications?

ie what should happen when significant proteinuria arises?

A

Admission advised:

  • 4 hourly BP
  • 24hr urine collection for protein
  • Daily urinalysis
  • Daily fetal assessment with CTG
  • Regular blood tests (every 2-3 days unless symptoms/signs worsen)
  • Regular USS = fortnightly growth and twice weekly doppler / liquor volume (depending on severity)
44
Q

What is the management of pre-eclampsia where BP so that systolic is >160mmHg OR diastolic >110mmHg?

A

Anti-HTN therapy should be started = not a cure but aims to prevent hypertensive complications

  • Methyldopa best for maintenance
  • Oral nifedipine used for initial control, IV labetalol as a 2nd line with severe HTN
45
Q

What is the target BP in the management of pre-eclampsia?

A

140/90mmHg

46
Q

What is the management of severe pre-eclampsia?

A

Team involves senior obstetric, anaesthetic and midwifery staff

BP management = aim for <160 systolic AND <110 diastolic

1) Initially PO nifedipine 10mg (can be given twice half an hour apart)
2) If BP remains high, start IV labetalol infusion (increase infusion rate until BP adequately controlled)
3) (IV hydralazine sometimes used)

Other management:

  • Bloods: FBC, U&Es, LFTs, clotting
  • Strict fluid balance chart (consider catheter)
  • CTG monitoring of fetus until condition stable
  • US fetus to determine if IUGR, establish weight if severely pre-term and to assess condition with umbilical artery Doppler velocimetry

If <34wks = give steroids

47
Q

What are some indications for immediate delivery in severe pre-eclampsia? (4)

A
  • Worsening thrombocytopenia or coagulopathy
  • Worsening liver or renal function
  • Severe maternal symptoms esp epigastric pain
  • Fetal reasons eg distress / reversed umbilical artery flow
  • HELLP syndrome eclampsia
48
Q

What is the usual method of delivery in severe pre-eclampsia?

A

Before 34wks = CS

After 34wks = IOL

49
Q

What should be given to prevent seizures?

A

Magnesium sulphate - reduces risk of eclampsia by more than half

50
Q

What is given to control seizures?

A

Magnesium sulfate

Loading dose of 4g given by infusion pump over 5-10mins, followed by a further infusion of 1g/hr maintained for 24hrs after the last seizure

51
Q

What is eclampsia?

A

One or more convulsions superimposed on pre-eclampsia

52
Q

How is eclampsia managed?

A

Resuscitation:

  • Pt put in left lateral position and airway secured
  • Oxygen

Treatment and prophylaxis of seizures:

  • Magnesium sulfate
  • Intubation may be necessary in women with repeated seizures

Treatment of HTN:

  • IV labetalol or hydralazine (both may precipitate fetal distress = continuous CTG)
  • BP must be reduced to raced risk of cerebrovascular accidents and risk of further seizures

Fluid therapy:

  • Close monitoring of fluid intake and urine output
  • Do not preload with colloid prior to regional anaesthesia

Delivery

53
Q

What is the postpartum management of eclampsia?

A
  • Stop methyldopa within 2 days and avoid diuretics if breastfeeding
  • Measure BP at least 4/day whilst in hospital and every 1-2 days after transfer to community care for at least 6 wks where urinalysis is checked
  • Measure FBC, LFT and creatinine 72hrs after birth
54
Q

What can be given in prevention of pre-eclampsia?

A

Low dose aspirin - 75mg from 12 weeks

Calcium supplementation

55
Q

When does HELLP syndrome occur?

A

In 0.5-0.9% of pregnancies and 10-20% of those with severe pre-eclampsia

HELLP syndrome may occur after pre-eclampsia is diagnosed (the norm) or be the first warning of pre-eclampsia when misdiagnosed eg hepatitis / thrombotic thrombocytopenia purport (TTP)

56
Q

What are some risk factors for HELLP syndrome? (7)

A

Age >35
Nulliparity
Previous gestational HTN Multiple pregnancy
Previous HELLP syndrome
Caucasian racial origin
Antiphospholipid syndrome (10.5% of patients with HELLP have APS)

57
Q

When does HELLP syndrome occur in pregnancy?

A

Usually rapid onset in second half of pregnancy

58
Q

How does HELLP syndrome present?

A

Symptoms usually nonspecific

  • 50% have headache
  • 20% have visual symptoms
  • Malaise, fatigue, RUQ / epigastric pain, n&v, flu-like symptoms
  • Some have easy bruising / purport
  • On examination, oedema, HTN and proteinuria may be present
  • Characterised by exacerbations of symptoms at night and relief during the day
  • +/- hepatomegaly
59
Q

What investigations are done for HELLP syndrome?

A
  • Haemolysis with fragmented RBC on film (due to microangiopathic) haemolytic anaemia
  • Raised LDH >600 IU / L with a raised bilirubin (due to destruction of RBC)
  • Liver enzymes are raised with AST or ALT level >70IU/L (due to liver injury)
  • Decreased platelets due to activation and increased consumption
60
Q

Ddx of HELLP syndrome?

A
  • Acute fatty liver of pregnancy
  • Thrombotic thrombocytopenia purpura (TTP)
  • Immune thrombocytopenia (ITP)
  • Haemolytic uraemic syndrome
  • Acute exacerbation of SLE
  • Viral hepatitis
  • Cholangitis
61
Q

What is the treatment of HELLP?

A

Definitive treatment is delivery of fetus and advised after 34wks gestation if multisystem is present

Extra 5 (e) (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions