Gestational hypertension and pre-eclampsia Flashcards
Gestational hypertension
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.
Diagnosis
2 readings >140/90
1 reading >170/110
Risk factors
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
Pre-eclampsia
A multi-system, multi-organ system disease characterised by hypertension and proteinuria
Investigation findings
Hypertension Proteinuria Thrombocytopenia Prolonged clotting times Raised creatinine and urea Abnormal LFTs Fetal growth retardation Oligohydramnios Abnormal uterine and umbilical artery doppler
Warning signs and symptoms
Headache Visual disturbances Peri-orbital oedema Epigastric pain Nausea and vomiting Hypereflexia Other oedema Reduced foetal movements
Complications
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
Management
Delivery only cure
Management aimed at improving maternal and foetal outcomes
Maternal management
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
Foetal management
IUGR assessment Oligohydramnios detection Uterine and umbilical artery dopplers Biophysical profile Dexamethasone if delivery <34w expected Timely delivery CTG
Delivery - when?
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
Delivery - how?
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
