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Obstetrics > GPH > Flashcards

GPH Flashcards

1
Q

What classifies proteinuria?

A

> 300mg in 24 hours

Seen with dipstix, cold test, DUP

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2
Q

What can cause proteinuria?

A

Renal impairment. Contaminants. GPH. Orthostatic proteinuria. UTI.

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3
Q

What is the pathophysiology of GPH?

A

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

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4
Q

Who is at increased risk of GPH?

A

Young primis.

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5
Q

From when until when does GPH occur?

A

From 20 weeks until after delivery

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6
Q

What is latent essential hypertension?

A

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

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7
Q

What renal disease can cause a gestational hypertension with proteinuria? And what are the clinical clues to this diagnosis?

A

Acute nephritis. Haematuria, granular casts

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8
Q

What causes HPT before 20/40?

A

Essential HPT. Chronic renal disease (GN, SLE). Other

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9
Q

What is unclassified hypertension?

A

Hypertension present at first visit when the booking takes place after 20 weeks

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10
Q

What is the Davey and McGillivray classification of hypertensive disease in pregnancy?

A

Gestational disease (>20/40). Chronic disease. Unclassified.

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11
Q

What important aspects are looked at in history?

A

Complaints of epigastric pain, headache, blurry vision. Fetal movements felt.

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12
Q

What is looked for on exam?

A

BP, fundi (looking for retinal detachment), oedema, reflexes, IUGR, liver enlargement/tenderness

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13
Q

What blood investigations are performed?

A

Platelets (accelerated consumption). LFTs- AST, ALT (HELLP). U&E, urate. Hb (haemolysis). LDH (haemolysis).

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14
Q

In what circumstances is the mother considered to be “at risk”?

A

Uncontrolled BP. Eclampsia. Imminent eclampsia. HELLP syndrome. Pulmonary oedema. Renal failure.

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15
Q

Why is a woman with uncontrolled HPT at increased risk?

A

DBP>120–> fibrinoid change and necrosis of small arterioles–> haemorrhage
Manage conservatively

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16
Q

Why is an eclamptic at increased risk?

A

Cerebrovascular haemorrhage. Cerebral oedema. Aspiration pneumonia. Multi-organ damage (HELLP, RF).

17
Q

How is imminent eclampsia diagnosed?

A

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

18
Q

What is HELLP?

A

Syndrome of haemolysis, elevated liver enzymes and low platelets

19
Q

What is the conservative management for GPH patients at no immediate risk?

A

Monitor in hospital. Give antiHPT if BO>160-110. Give BMZ. Deliver is risk develops for mother or fetus if >2kg or >34/40.

20
Q

What is the definition of hypertension in pregnancy?

A

Persistently elevated DBP >90 (x2, 4 hours apart) OR DBP>100 (x1)

21
Q

What is the standard treatment of hypertension in pregnancy?

A

Methyldopa (a-blocker)

22
Q

What drug is used as a rescue drug for hypertension spikes in pregnancy and what is the dose and delivery?

A

Adalat (Nifedipine) - CCB- 10mg sublingually

23
Q

Prevention for GPH?

A

Aspirin 80mg/day in high risk patients

24
Q

How do you manage eclamptic fits?

A

Diazepam or clonazepam 1mg PRN IV

25
Q

How are fits prevented in GPH?

A

MgSO4 IV infusion
Loading dose 4g in 200ml - 5% D/W 30 mins
Then 4g in 200ml - 5% DW 1g/hr

26
Q

How does MgSO4 work?

A

It reduces the excitability of cells and reduces Ca++ entry into the cell.
reducing the risk of first seizure and recurring seizures

27
Q

When is MgSO4 treatment stopped?

A

24 hours after delivery or last seizure

28
Q

What are signs of MgSO4 toxicity?

A

Areflexia

29
Q

How is MgSO4 toxicity reversed?

A

Calcium gluconate

30
Q

How do manage GPH diagnosed at

A

Get patient to 28 weeks and deliver.

31
Q

How do you manage a GPH patient diagnosed between 28-34/40?

A

Admit, do GPH bloods, tox chart
Give BMZ, load with MgSO4
Deliver at 34/40

32
Q

How do manage a GPH patient diagnosed after 34/40?

A

Admit, give MgSO4

Deliver

Obstetrics (18 decks)

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