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Reproductive System > Complicated Pregnancy - Hypertension > Flashcards

Complicated Pregnancy - Hypertension Flashcards

1
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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2
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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3
Q

What management should be taken for chronic hypertension?

A
  • Avoid certain drugs: ACEIs, ARBs, Diuretics
  • Aim to keep BP<150/100 (labetolol, methyldopa, nifedipine)
  • Monitor fetal growth
  • Monitor for superimposed pre-eclampsia
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4
Q

Define Gestational Hypertension

A

Hypertension developing >20wks

Prior to that its considered overt chronic hypertension unrelated to pregnancy

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5
Q

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

A

New Hypertension >20 wks associated with significant proteinuria

  • Automated reagent strip urine protein estimation > 1+
  • Spot Urinary Protein: Creatinine Ratio > 30 mg/mmol
  • 24 hours urine protein collection > 300mg/ day
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6
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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7
Q

What are the risk factors for Pre-eclampsia?

A
  • 1st pregnancy
  • Multiple pregnancy
  • Pregnancy interval >10rys
  • Extreme Maternal Age
  • BMI >35
  • FH
  • Underlying medical disorders incl: -
    • Chronic HT
    • Renal Disease
    • DM
    • Autoimmune e.g. SLE
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8
Q

What are the major maternal complications of Pre-eclampsia?

A
  • Seizures (eclampsia)
  • Severe hypertension àcerebral haemorrhage, stroke
  • HELLP (haemolysis, elevated liver enzymes, low platelets)
  • DIC (disseminated intravascular coagulation)
  • Renal failure
  • Pulmonary oedema, cardiac failure
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9
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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10
Q

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

A
  • Headaches
  • Blurred vision
  • Vomiting
  • Swelling of the hands, face and legs!
  • Epigastric Pain!
  • Convulsions
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11
Q

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

A
  • Clonus and brisk reflexes!
  • Papilloedema
  • Epigastric pain
  • Reduced Urinary Output
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12
Q

Why do pre-eclampsia sufferers get epigastric pain?

A

Liver Congestion from the high BP

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13
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) and bilirubin if HELLP present
  • Raised urea + creatinine and urate (kidney damage)
  • Low haemoglobin (HELLP)
  • Low platelets and fibrinogen
  • Coagulation Tests - INR and D-dimer for DIC
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14
Q

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

A

With cardiotocography (CTG)

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15
Q

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

A

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

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16
Q

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

A
  1. Conservative management aiming for delivery
  2. Inducing labour should need be
  3. Seizure management
  4. Prophylaxis in subsequent pregnancies
17
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
18
Q

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

A

Steroids for fetal lung maturity if gestation < 36wks

19
Q

How do we manage a patient with 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)
20
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

21
Q

What are the major Fetal complications of pre-eclampsia?

A
  • Impaired placental perfusion → Inter-uterine Growth Restriction (IGUR), fetal distress, prematurity,
  • Increased PN mortality
22
Q

What is DIC?

A

Disseminated intravascular coagulation

Reproductive System (26 decks)

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