Complications of pregnancy 2 (preeclampsia) Flashcards
When hypertension is diagnosed either before pregnancy or at booking - what blood pressures correspond with:
a) Mild HT
b) Moderate HT
c) Severe HT
a) Mild HT:
- Systolic BP 140-149
- Diastolic BP 90-99
b) Moderate HT:
- Systolic BP 150-159
- Diastolic BP 100-109
c) Severe HT:
- Systolic BP ≥ 160
- Diastolic BP ≥ 110
What are the hypertensive disorders of pregnancy?
Gestational hypertension / PIH (pregnancy induced hypertension
Pre-eclampsia
What is gestational hypertension?
the development of new hypertension in a pregnant woman after 20 weeks’ gestation - without proteinuria or other signs of preeclampsia
BP increases normally in pregnancy - but this is abnormally high, high blood pressure
What is pre-eclampsia?
The development of new hypertension in a pregnant woman >20 weeks gestation - with significant proteinuria
BP must be
For pre-eclampsia to be diagnosed - there must be significant proteinuria
How much is ‘significant’?
Spot urinary protein : creatinine ratio of >30 mg/mmol
or
Automated reagent strip urine protein estimation of >1+
or
24 hour urine protein collection >300mg/day
Which antihypertensive drugs should be avoided in pregnant women? (women of child bearing age)
ACEIs - Ramipril etc
ARBs - Candesartan etc
What criteria is required for the diagnosis of pre-eclampsia?
1) Well obviously they need to be pregnant
2) New hypertension:
- If Mild HT - 2 positive BP readings more than 4 hours apart
- If severe HT - only 1 reading is needed
3) Proteinuria - 1 of the following:
- 300 mg/day
- Spot urinary protein : creatinine ratio >30mg/mmol
- ARSUP estimation >1+
What medications are often used for treatment of chronic hypertension in pregnant women?
What is the BP aim?
Medications:
- labetolol (bb)
- nifedipine (ccb)
- methyldopa
Aim to keep BP < 150/100
Describe the basic pathophysiology of pre-eclampsia
(v basic bc its absolute aids)
There is development of an abnormal placenta:
- Fibrous and narrow uteroplacental arteries lead to hypoperfusion of the placenta
- This hypoperfusion causes pro-inflammatory proteins to be released which cause widespread vasoconstriction and the kidneys to retain more salt
- leading to hypertension
and some other stuff happens
What are the risk factors for pre-eclampsia?
High risk factors:
- Chronic kidney disease
- Autoimmune diseases - SLE & anti-phospholipid
- Diabetes
- Chronic hypertension
- Pre-eclampsia in previous pregnancy (+ complications)
Moderate risk factors:
- First pregnancy or multiple pregnancies
- Age > 40
- Pregnancy interval > 10 years
- Family history
- High BMI (>35)
What are the maternal complications of pre-eclampsia?
Eclampsia
Severe hypertension - haemorrhagic strokes
HELLP syndrome
DIC - disseminated intravascular coagulation
Renal failure
Pulmonary oedema & heart failure
What is eclampsia and how does it develop?
When a patient with pre-eclampsia begins having seizures
It happens due to cerebral oedema - which can occur in severe pre-eclampsia
What is HELLP syndrome and how does it happen in pre-eclampsia?
Haemolysis, Elevated Liver enzymes, Lower Platelets
In pre-eclampsia - tiny thrombi can form in the microvasculature due to endothelial cell injury
Haemolysis - due to RBCs smashing against these thrombi
Elevated liver enzymes - due to liver damage from pre-eclampsia
Lower platelets - fuck ton of platelets are used up making these tiny thrombi
What are the fetal complications of pre-eclampsia?
Impaired placental perfusion can cause:
- IUGR - intrauterine growth restriction
- Fetal distress
- Premature birth
- Increased perinatal mortality
Complications such as placental abruption / APH are linked to the hypertensive aspect
What are the symptoms of severe pre-eclampsia?
Headache
Epigastric / RUQ pain
Vomiting
Pain below ribs
Blurred vision
Oliguria
