Complicated Pregnancy 3

Question 1

This Deck will cover Hypertensive Disorders including:

Answer 1

Chronic HT
Pre-eclampsia
Gestational HT

Question 2

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

Answer 2

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

Question 3

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

Answer 3

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

Question 4

What anti-hypetensive drugs should be avoided in pregnancy?

Answer 4

ACEIs & ARBs

Question 5

Define Gestational Hypertension?

Answer 5

Hypertension developing >20wks
Prior to that its considered overt chronic hypertension unrelated to pregnancy

Question 6

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

Answer 6

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

Significant proteinuria

Question 7

How do we test for proteinuria in pregnancy?

Answer 7

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

Question 8

What are the risk factors for Pre-eclampsia?

Answer 8

• 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

Question 9

What are the major complications of Pre-eclampsia?

Answer 9

• Seizures (eclampsia)
• Haemorrhage & Stroke
• HELLP
• DIC
• Renal Failure
• Pulm Oedema & HF
• Impaired placental perfusion

Question 10

What is HELLP?

Answer 10

A potential consequence of pre-eclampsia where you get:
- Haemolysis
- Elevated Liver enzymes
- Low Platelets

Question 11

Pre-eclampsia can cause impaired placental perfusion, what are the consequences of this?

Answer 11

• IUGR
• Foetal Distress
• Prematurity
• Mortality

Question 12

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

Answer 12

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

Question 13

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

Answer 13

• Clonus & brisk reflexes!
• Papilloedema
• Reduced Urinary Output
• Swelling of hands, face and legs!

Question 14

Why do pre-eclampsia sufferers get epigastric pain?

Answer 14

Liver Congestion from the high BP

Question 15

What blood tests are relevant to Pre-eclampsia and why?
Think about congestion in liver, damage to kidneys, complications etc.

Answer 15

LFTs - Raised liver enzymes due to congestion & HELLP
Bilirubin - HELLP
U&C + Urate - Kidney Damage

FBC
- low haemoglobin (HELLP)
- Low platelets & fibrinogen (DIC)

Coagulation Tests
- INR & D-dimer for DIC

Question 16

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

Answer 16

With Cardiotocography (CTG)

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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?

Answer 19

NOT ACEI/ARBs

• Labetolol
• Methyldopa
• Nifedipine

Question 20

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

Answer 20

Steroid!

Question 21

How do we manage a patient who has eclampsia?

Answer 21

• 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)

Question 22

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

Answer 22

Low does aspirin from 12 weeks until delivery