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Repro > Complicated Pregnancy 2 - Hypertension > Flashcards

Complicated Pregnancy 2 - Hypertension Flashcards

1
Q

This Deck will cover Hypertensive Disorders including:

A

Chronic HT
Pre-eclampsia
Gestational HT

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2
Q

Define the different levels of hypertension (Mild - moderate - severe)

A 
Mild = >140/90
Moderate = >160/100
Severe = DBP >110 or SBP >180
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3
Q

How do you know if a patient’s hypertension is Chronic?

A

If it was discovered pre-pregnancy or within the first 20 wks

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4
Q

What management should be taken for chronic hypertension?

A

Avoid certain drugs:

  • ACEIs & ARBs
  • Diuretics
  • Aim to keep BP<150/100
  • Monitor fatal growth
  • Monitor for superimposed pre-eclampsia
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5
Q

Define Gestational Hypertension?

A

Hypertension developing >20wks

Prior to that its considered overt chronic hypertension unrelated to pregnancy

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6
Q

What criteria are required for a diagnosis of pre-eclampsia?

A

New Hypertension >20 wks -Mild HT twice more 4 hours apat
-Moderate/Severe HT on one reading)

Significant proteinuria
-more than 300mg/24hrs

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7
Q

How do we test for proteinuria in pregnancy?

A

Urine Dipstick
Spot Urinary Protein:Creatinine ratio
24Hr urine protein collection

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8
Q

What are the risk factors for Pre-eclampsia?

A
  • 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
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9
Q

What are the major Maternal complications of Pre-eclampsia?

A

Maternal

  • Seizures (eclampsia)
  • Haemorrhage & Stroke
  • HELLP
  • DIC
  • Renal Failure
  • Pulm Oedema & HF
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10
Q

What is HELLP?

A

A potential consequence of pre-eclampsia where you get:

  • Haemolysis- destruction of RBCs
  • Elevated Liver enzymes
  • Low Platelets
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11
Q

Many cases are asymptomatic and picked up on antenal assessment. We should look for symptoms indicating the condition is deteriorating such as:

A
  • Headaches & blurred vision
  • Vomiting
  • Swelling of the hands, face & legs!
  • Epigastric Pain!
  • Convulsions
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12
Q

What signs can be picked up on exam of Pre-eclampsia?

A
  • Clonus & brisk reflexes!
  • Papilloedema
  • Epigastric pain
  • Reduced Urinary Output
  • Swelling of hands, face and legs!
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13
Q

Why do pre-eclampsia sufferers get epigastric pain?

A

Liver Congestion from the high BP

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14
Q

What blood tests are relevant to Pre-eclampsia and why?

Think about congestion in liver, damage to kidneys, complications etc.

A

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

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15
Q

How do we monitor the foetus’s condition re pre-eclampsia?

A

With Cardiotocography (CTG)

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16
Q

How long should we continue monitoring the mother’s BP, urine protein & symptoms?

A

Through the Peurperium as the risk remains for the first 6 wks after delivery

17
Q

Treatment of pre-eclampsia can be split into 4 stages:

A
  • Conservative management aiming for delivery
  • Inducing labour should need be
  • Seizure management
  • Prophylaxis in subsequent pregnancies
18
Q

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?

A

NOT ACEI/ARBs

  • Labetolol
  • Methyldopa
  • Nifedipine
19
Q

How can we speed up the maturation of the foetus so we can deliver sooner?

A

Steroid!

20
Q

How do we manage a patient who has eclampsia?

A
  • 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)
21
Q

What can we give a mother as prophylaxis if she’s had pre-eclampsia in past pregnancies?

A

Low dose aspirin from 12 weeks until delivery

22
Q

what are the major Fetal complications of pre-eclampsia?

A

Impaired placental perfusion

  • IUGR: intrauterine growth restriction
  • Fetal distress
  • Prematurity PN mortality
23
Q

What is DIC?

A

Disseminated intravascular coagulation

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