High BP, pre eclampsia + diabetes Flashcards
what % of pregnancies do women suffer from high BP?
2-15%
High BP in these indicate:
<20 weeks
>20 weeks and no proteinuria
>20 weeks and POSITIVE proteinuria
pre existing or molar pregnancies
gestational hypertension
Pre eclampsia
High risk factors for high BP/Pre eclampsia?
chronic htn
CKD
aPL/SLE
T1/2DM
pHx Pre eclampsia
Moderate risk factors for high BP/pre eclampsia?
1st pregnancy
40+ yrs old
>35 BMI at booking
multiple preg
family Hx pre eclampsia
Sx of High BP?
> / 140/90 BP
Mild = aSx
severe if 1 or more = vision changes, headaches, abdo pain, RUQ pain, oliguria, oedema + HYPERREFLEXIA
dx of high BP?
FBC (inc platelets)
U+E
LFT
TFT Clotting
A:Cr (/uric acid)
Urine dip +ve protein (0.3g/24hr+)
BP
Tx for high BP?
IF asthmatic?
If pre existing?
Labetalol
nifedipine (if asthmatic)
if pre existing, stop other antihypertensives
Definitive treatment for high BP?
stable and unstable
delivery
stable = 37 weeks
severe = before that
if a patient has a high risk of DVT, 1 high or 2 mod RF, what is given and how much?
75-150mg aspirin from 12 weeks - birth
low dose
what is a high dose of aspirin?
300mg
What is the physiology of pre eclampsia?
The spiral become more fibrous and narrower, so less blood flows through them which can cause poor intrauterine growth/death
Pro inflammatory proteins are released into the mothers circulation to cause vasoconstriction and kidneys retain more salt to cause hypertension so more blood to foetus
Higher pressure - more risk of stroke/abruption
what is pre eclampsia?
more than 20 weeks, hypertension + proteinuria
Other Sx of pre eclampsia?
Peripheral oedema
headaches
drowsiness
visual disturbances
epigastric pain
N+V
HYPERREFLEXIA
fetal complications of pre eclampsia?
IUGR
Pre term delivery
placental abruption
neonatal hypoxia
maternal complications of pre eclamsia?
Eclampsia (seizures due to cerebrovascular vasospasm)
organ failure
DIC
HELLP syndrome
What is given for eclampsia (seizures)?
ABCDE
Give MgSO4 IV 4g loading then 1g/h
Corticosteroid
Deliver baby (c section or induced)
What do we need to monitor in eclampsia treatment and why?
Monitor MgSO4 for Mg toxicity =.BP, RR, DTR
SE of magnesium toxicity?
sweating, flushing, hypotension, low temp, dizzy
what do you give for an MgSO4 overdose?
calcium gkuconate
What is HELLP syndrome?
What do you see?
On bloods you will see Haemolysis, Elevated liver enzymes and Low platelets
High DTR (deep tendon reflex), RUQ pain and N+V
Tx for HELLP and when?
Deliver baby asap
after 34 weeks NICE
What % of pregnancy women suffer from diabetes?
2-10%
Pre existing affects %?
fetal abnormalities or non?
15%
Fetal abnormalities
CHD (esp TGA)
NTDs (neural tube defect)
Situs inversus (organs on opposite side of body)
IUGR
Macrosomia
Control - 3/3 means increased insulin needs, more hypos, more macro/micro comps
Gestational affects %?
fetal abnormalities or non?
85%
No fetal abnormalities - EXCEPT MACROSOMIA + POLYHYDROMNIOS
related to high hPL + neonatal hypoglycaemia, high risk of DM
RF for gestational diabetes?
PCOS
Pre exlampsia
htn
obesity
fHx
DM
Dx of diabetes? AND RESULTS?
OGTT 24-28 weeks (2 readings = Dx) - 5678!!!
FPG >/ 5.6
OGTT 2H >/ 7.7
If px has has past med Hx of gest DM, When are they tested for it?
test at booking and at 24-28 weeks
What are the targets for FPG & OGTT?
<5.3 FPG
<6.4 OGTT 2H
when the FPG is between 6-6.9 and baby is macrosomic, what is given as treatment?
Insulin
Treatment for:
FPG /< 7
FPG >/ 7
7 OR LESS - mod of 1-2 week diet and exercise
If not resolving, offer metformin, still not, add insulin
7 or more - Insulin, diet and exercise +/- metformin
what needs too be taught to the Px in gest diabetes?
if they have pre existing DM, what should happen?
how to monitor BMs
Stop all DM drugs except metformin and insulin
What happens to gestational DM treatment postnatally?
Stop meds
6-13 weeks gp check hba1C
annual follow up
Pre pregnancy investigations for diabetes?
Renal - u+E, eGFR, urine, A:Cr
Retinal - fundoscopy
Complications of diabetes in pregnancy?
polyhydromnios, macrosomia, traumatoic birth, perinatal death, neonatal hypos, 50% Gest DM Turn into T2DM
