blood pressure in pregnancy Flashcards
BP rises/falls in early pregnancy
falls due to vasodilatation
after 24 weeks, BP increases/decreases
increases due to increased SV
if hypertension in early pregnancy (<24 weeks) what is most likely cause
pre-existing hypertension
complications of hypertension in pregnancy
Pre-eclamptic toxaemia (PET)
IUGR
placental abruption
what medications should not be used in pregnancy
ACE inhibitors
A2A blockers
thiazide diuretics
what medications should be used in pregnancy
labetalol
methyldopa
aspirin
why should just oxytocin be given during labour and not oxytocin with ergometrine
ergometrine can cause severe hypertension
what is pre-eclampsia
hypertension
proteinuria
oedema
time of early pre-eclampsia
<34 weeks
time of late pre-eclampsia
> 34 weeks
early/late pre-eclampsia if higher risk
early
early/late pre-eclampsia is more common
late
stage one of pre-eclampsia
abnormal placental diffusion (ischaemia)
stage 2 of pre-eclampsia
maternal syndrome - anti angiogenic state associated with endothelial dysfunction
CNS manifestations of pre-eclampsia
eclampsia hypertensive encephalopathy intracranial haemorrhage cerebral oedema cortical blindness cranial nerve palsy
hepatic disease in pre-eclampsia
epigastric/RUQ pain
abnormal LFTs
hepatic capsule rupture
HELLP syndrome
cardiac/pulmonary disease in pre-eclampsia
pulmonary oedema
pulmonary embolus
placental disease in pre-eclampsia
foetal growth restriction
placental abruption
intrauterine dearh
symptoms of pre-eclampsia
headache visual disturbance epigastric/RUQ pain nausea/vomiting rapidly progressive oedema
management of pre-eclampsia
treat hypertension
risk factors for pre-eclampsia
maternal age >40 maternal BMI>30 family history single paritiy multiple pregnancy prev PE molar pregnancy pre-existing renal/connective tissue disease/diabetes/hypertension/thrombophilia
why is aspirin given in pre-eclampsia
inhibits cyclo-oxygenase preventing TXA2 synthesis
investigations for pre-eclampsia
raised protein-creatinine ratio raised serum uric acid thrombocytopenia abnormal LFTs nothcing of uterine artery on Doppler and abnormal umbilical arteries
when should patients with pre-eclampsia be admitted
BP >170/110 or 140/90 with proteinuria significant symptoms (headache/vision/abdo pain abnormal biochemistry significant proteinuria need for antihypertensives signs pf foetal compromise
1st line treatment of pre-eclampsia
methyl dopa (a agonist)labetalol (a and b antagonist) nifedipine (CCB)
2nd line treatment for pre-clampsia
hydralazine (vasodilator)
doxazocin (a antagonist)
indications for birth
inability to control BP term gestation rapidly deteriorating eclampsia foetal compromise
what is eclampsia
tonic-clonic seizure occurring with features of pre-eclampsia (obstetric emergency)
most common group of people to get eclampsia
teenagers
management of eclampsia
control BP
stop/prevent seizures
fluid balance
delivery
what medication for hypertension in eclampsia
IV labetolol
IV hydralazine
what medication to stop/prevent seizures in eclampsia
magnesium sulphate
main cause of maternal death in eclampsia
pulmonary oedema
