Complications in Pregnancy 2 Flashcards
outline the different hypertensive disorders in pregnancy
-
Chronic HT
- hypertension either pre-pregnancy or at booking appointment
- mild - 140/90
- moderate -150/100
- severe -160/110>
- hypertension either pre-pregnancy or at booking appointment
-
Gestational HT
- as above but develops after >20weeks
- Pre-Eclampsia (PET)
what is the definition of PET?
Gestational HT
either
- mild HT
- on 2 occasions more than 4 hours apart
- moderate / severe HT
with significant proteinuria
- >300mg/day
- >1+ protein on reagent strip
- creatinine ratio >30mg/mmol
what is pre-pregnancy care for chronic HT?
- may have to change certain medications
- ACEI cause birth defects
- suitable anti-hypertensives in pregnancy:
- CCB
- Beta-Blocker
- Methyldopa
- aim to keep BP <150/100
what is the pathophysiology of PET?
- immunological / genetic predisposition
-
defective invasion of mother’s spiral arterioles by trophoblast cells
- reduced placental perfusion
- imbalance between vasoconstrictors and vasodilators - vasospasm
risk factors of PET?
- high BMI (>30)
- previous PET
- multiple pregnancy
- 1st pregnancy
complications of PET?
- eclampsia - seizures
- severe HT
- cerebral haemorrhage / stroke
- renal failure
- DIC
- cardaic failure / pulmonary oedema
- HELLP
- haemolysis/raised liver enzymes/ low platelets
- foetal distress
what are symptoms / signs of severe PET?
blurred vision / headache / epigastric pain/ vomiting / swelling of limbs / clonus / brisk reflexes / reduced urine output
what can the signs/ symptoms of PET be explained by?
local vasospasm which reduces perfusion to organs
what is severe PET characterised by?
severe HT OR >3+ proteinuria
biochemical and haematological abnormalities of PET
- biochemical
- raised liver enzymes
- increased creatinine, urea and urate
- haematological
- reduced platelets and Hb
management of PET?
Only cure = delivery of baby and membranes
management:
- conservative treatment
- close observation
- anti-hypertensives
- if deterioration in mother or foetal condition, induction of labour / C section
what % of women with PET go on to develop Eclampsia?
0.05%
treatment of eclamptic seizures?
- magnesium sulphate bolus + IV infusion
- IV Labetolol
what would you give a woman with previous PET for prophylaxis in next pregnancy?
low dose aspirin at 12 weeks until delivery
what occurs with pre-existing diabetes, in pregnancy?
- insulin requirement of mother goes up
- due to anti-insulin effects of progesterone, cortisol and B-HCG produced by placenta
- hyperinsulinaemia in foetus
- glucose travels across placenta and causes an increase in foetal insulin levels
- this may cause macrosomia (overly large foetus)
- post-delivery: risk of neonatal hypoglycaemia
