Complicated Pregnancy 2 - Hypertension Flashcards
This Deck will cover Hypertensive Disorders including:
Chronic HT
Pre-eclampsia
Gestational HT
Define the different levels of hypertension (Mild - moderate - severe)
Mild = >140/90 Moderate = >160/100 Severe = DBP >110 or SBP >180
How do you know if a patient’s hypertension is Chronic?
If it was discovered pre-pregnancy or within the first 20 wks
What management should be taken for chronic hypertension?
Avoid certain drugs:
- ACEIs & ARBs
- Diuretics
- Aim to keep BP<150/100
- Monitor fatal growth
- Monitor for superimposed pre-eclampsia
Define Gestational Hypertension?
Hypertension developing >20wks
Prior to that its considered overt chronic hypertension unrelated to pregnancy
What criteria are required for a diagnosis of pre-eclampsia?
New Hypertension >20 wks -Mild HT twice more 4 hours apat
-Moderate/Severe HT on one reading)
Significant proteinuria
-more than 300mg/24hrs
How do we test for proteinuria in pregnancy?
Urine Dipstick
Spot Urinary Protein:Creatinine ratio
24Hr urine protein collection
What are the risk factors for Pre-eclampsia?
- 1st pregnancy
- Multiple pregnancy
- Pregnancy interval >10rys
Extreme Maternal Age
BMI >35
FH
H/O
Underlying Medical Disorders incl:
- Chronic HT
- Renal Disease
- DM
- Autoimmune e.g. SLE
What are the major Maternal complications of Pre-eclampsia?
Maternal
- Seizures (eclampsia)
- Haemorrhage & Stroke
- HELLP
- DIC
- Renal Failure
- Pulm Oedema & HF
What is HELLP?
A potential consequence of pre-eclampsia where you get:
- Haemolysis- destruction of RBCs
- Elevated Liver enzymes
- Low Platelets
Many cases are asymptomatic and picked up on antenal assessment. We should look for symptoms indicating the condition is deteriorating such as:
- Headaches & blurred vision
- Vomiting
- Swelling of the hands, face & legs!
- Epigastric Pain!
- Convulsions
What signs can be picked up on exam of Pre-eclampsia?
- Clonus & brisk reflexes!
- Papilloedema
- Epigastric pain
- Reduced Urinary Output
- Swelling of hands, face and legs!
Why do pre-eclampsia sufferers get epigastric pain?
Liver Congestion from the high BP
What blood tests are relevant to Pre-eclampsia and why?
Think about congestion in liver, damage to kidneys, complications etc.
LFTs - Raised liver enzymes due to congestion &
Bilirubin - HELLP
U&C + Urate - Kidney Damage
FBC
- low haemoglobin (HELLP)
- Low platelets & fibrinogen (DIC)
Coagulation Tests
- INR and D-dimer for DIC
How do we monitor the foetus’s condition re pre-eclampsia?
With Cardiotocography (CTG)
How long should we continue monitoring the mother’s BP, urine protein & symptoms?
Through the Peurperium as the risk remains for the first 6 wks after delivery
Treatment of pre-eclampsia can be split into 4 stages:
- Conservative management aiming for delivery
- Inducing labour should need be
- Seizure management
- Prophylaxis in subsequent pregnancies
The ideal goal with pre-eclampsia is to control BP through to maturity and normally deliver the baby, what drugs can we use as hypertensives for this purpose?
NOT ACEI/ARBs
- Labetolol
- Methyldopa
- Nifedipine
How can we speed up the maturation of the foetus so we can deliver sooner?
Steroid!
How do we manage a patient who has eclampsia?
- Magnesium sulphate bolus & IV infusion to control the convulsions
- IV Labetolol &Hydralazine if the BP is >160/110
- Controlled fluids to avoid overload (aim for 80mls/hr intake)
What can we give a mother as prophylaxis if she’s had pre-eclampsia in past pregnancies?
Low dose aspirin from 12 weeks until delivery
what are the major Fetal complications of pre-eclampsia?
Impaired placental perfusion
- IUGR: intrauterine growth restriction
- Fetal distress
- Prematurity PN mortality
What is DIC?
Disseminated intravascular coagulation
