Gestational hypertension and pre-eclampsia Flashcards

1
Q

Gestational hypertension

A

Pregnancy-induced hypertension which develops after 20 weeks of gestation and may be either transient hypertension of pregnancy or chronic hypertension identified in the latter half of pregnancy.

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2
Q

Diagnosis

A

2 readings >140/90

1 reading >170/110

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3
Q

Risk factors

A
Extremes of age
Previous history
Family history
Primip/first baby in ten years/first baby to new partner
Obesity
Diabetes
Renal disease
Antiphospholipid syndrome
Pre-existing hypertension
Molar pregnancy
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4
Q

Pre-eclampsia

A

A multi-system, multi-organ system disease characterised by hypertension and proteinuria

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5
Q

Investigation findings

A
Hypertension
Proteinuria
Thrombocytopenia
Prolonged clotting times
Raised creatinine and urea
Abnormal LFTs
Fetal growth retardation
Oligohydramnios
Abnormal uterine and umbilical artery doppler
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6
Q

Warning signs and symptoms

A
Headache
Visual disturbances
Peri-orbital oedema
Epigastric pain
Nausea and vomiting
Hypereflexia
Other oedema
Reduced foetal movements
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7
Q

Complications

A
Eclampsia
HELLP (Haemolysis; Elevated Liver enzymes; Low Platelets)
Cerebral haemorrhage (commonest cause of death)
DIC
Renal failure
Hepatic rupture
Pulmonary oedema
Placental abruption
Foetal death
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8
Q

Management

A

Delivery only cure

Management aimed at improving maternal and foetal outcomes

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9
Q

Maternal management

A

Control hypertension (labetalol; methydopa; hydralazine; nifedipine)
Urgent reduction if >170/110
Admit
Monitor renal, liver and clotting parameters
Rising uric acid and falling platelets indicate deterioration in maternal condition and delivery should be considered
Deliver if HELLP or hypereflexia
?Prophylactic MgSO4 ?Prophylactic low dose aspirin

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10
Q

Foetal management

A
IUGR assessment
Oligohydramnios detection
Uterine and umbilical artery dopplers
Biophysical profile
Dexamethasone if delivery <34w expected
Timely delivery
CTG
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11
Q

Delivery - when?

A

PIH: induction by 40 weeks
Mild pre-eclampsia: delivery by 37 weeks
Moderate/severe: delivery after 34-36 weeks. Before 34 weeks, conservative management in specialist unit, give steroids, treat hypertension and intensive surveillance
Severe pre-eclampsia with complications or fetal distress: delivery whatever gestation

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12
Q

Delivery - how?

A

34weeks: Induced with prostaglandins
Epidural analgesia helps reduce blood pressure
Continuous CTG
Blood pressure and fluid balance closely observed
Antihypertensives used
Maternal pushing should be avoided if blood pressure reaches 160/110 in second stage due to risk of cerebral haemorrhage
Oxytocin rather than ergometrine for 3rd stage

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