GPH Flashcards
What classifies proteinuria?
> 300mg in 24 hours
Seen with dipstix, cold test, DUP
What can cause proteinuria?
Renal impairment. Contaminants. GPH. Orthostatic proteinuria. UTI.
What is the pathophysiology of GPH?
Failed 2nd ohasw trophoblast invasion-> abnormal spiral arterioles-> under perfused choriodecidual space -> endothelial dysfunction -> IUGR and maternal peripheral vasospasm in response to hyper dynamic circulation which results in hypertension
Who is at increased risk of GPH?
Young primis.
From when until when does GPH occur?
From 20 weeks until after delivery
What is latent essential hypertension?
Recurring hypertension of pregnancy in women predisposed to develop hypertension. It is transient and reversible, brought about by pregnancy, as well as increase in weight or salt intake
What renal disease can cause a gestational hypertension with proteinuria? And what are the clinical clues to this diagnosis?
Acute nephritis. Haematuria, granular casts
What causes HPT before 20/40?
Essential HPT. Chronic renal disease (GN, SLE). Other
What is unclassified hypertension?
Hypertension present at first visit when the booking takes place after 20 weeks
What is the Davey and McGillivray classification of hypertensive disease in pregnancy?
Gestational disease (>20/40). Chronic disease. Unclassified.
What important aspects are looked at in history?
Complaints of epigastric pain, headache, blurry vision. Fetal movements felt.
What is looked for on exam?
BP, fundi (looking for retinal detachment), oedema, reflexes, IUGR, liver enlargement/tenderness
What blood investigations are performed?
Platelets (accelerated consumption). LFTs- AST, ALT (HELLP). U&E, urate. Hb (haemolysis). LDH (haemolysis).
In what circumstances is the mother considered to be “at risk”?
Uncontrolled BP. Eclampsia. Imminent eclampsia. HELLP syndrome. Pulmonary oedema. Renal failure.
Why is a woman with uncontrolled HPT at increased risk?
DBP>120–> fibrinoid change and necrosis of small arterioles–> haemorrhage
Manage conservatively
Why is an eclamptic at increased risk?
Cerebrovascular haemorrhage. Cerebral oedema. Aspiration pneumonia. Multi-organ damage (HELLP, RF).
How is imminent eclampsia diagnosed?
Symptomatic patients (headache, visual disturbances)
Hyperreflexia - clonus
Rapid fluid retention causing increase in weight, and generalized oedema.
Need to give colloid fluid and seizure prophylaxis
What is HELLP?
Syndrome of haemolysis, elevated liver enzymes and low platelets
What is the conservative management for GPH patients at no immediate risk?
Monitor in hospital. Give antiHPT if BO>160-110. Give BMZ. Deliver is risk develops for mother or fetus if >2kg or >34/40.
What is the definition of hypertension in pregnancy?
Persistently elevated DBP >90 (x2, 4 hours apart) OR DBP>100 (x1)
What is the standard treatment of hypertension in pregnancy?
Methyldopa (a-blocker)
What drug is used as a rescue drug for hypertension spikes in pregnancy and what is the dose and delivery?
Adalat (Nifedipine) - CCB- 10mg sublingually
Prevention for GPH?
Aspirin 80mg/day in high risk patients
How do you manage eclamptic fits?
Diazepam or clonazepam 1mg PRN IV
How are fits prevented in GPH?
MgSO4 IV infusion
Loading dose 4g in 200ml - 5% D/W 30 mins
Then 4g in 200ml - 5% DW 1g/hr
How does MgSO4 work?
It reduces the excitability of cells and reduces Ca++ entry into the cell.
reducing the risk of first seizure and recurring seizures
When is MgSO4 treatment stopped?
24 hours after delivery or last seizure
What are signs of MgSO4 toxicity?
Areflexia
How is MgSO4 toxicity reversed?
Calcium gluconate
How do manage GPH diagnosed at
Get patient to 28 weeks and deliver.
How do you manage a GPH patient diagnosed between 28-34/40?
Admit, do GPH bloods, tox chart
Give BMZ, load with MgSO4
Deliver at 34/40
How do manage a GPH patient diagnosed after 34/40?
Admit, give MgSO4
Deliver
