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Phase 3a Obstetrics + sexual health > High BP, pre eclampsia + diabetes > Flashcards

High BP, pre eclampsia + diabetes Flashcards

1
Q

what % of pregnancies do women suffer from high BP?

A

2-15%

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2
Q

High BP in these indicate:
<20 weeks
>20 weeks and no proteinuria
>20 weeks and POSITIVE proteinuria

A

pre existing or molar pregnancies

gestational hypertension

Pre eclampsia

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3
Q

High risk factors for high BP/Pre eclampsia?

A

chronic htn
CKD
aPL/SLE
T1/2DM
pHx Pre eclampsia

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4
Q

Moderate risk factors for high BP/pre eclampsia?

A

1st pregnancy
40+ yrs old
>35 BMI at booking
multiple preg
family Hx pre eclampsia

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5
Q

Sx of High BP?

A

> / 140/90 BP
Mild = aSx
severe if 1 or more = vision changes, headaches, abdo pain, RUQ pain, oliguria, oedema + HYPERREFLEXIA

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6
Q

dx of high BP?

A

FBC (inc platelets)
U+E
LFT
TFT Clotting
A:Cr (/uric acid)
Urine dip +ve protein (0.3g/24hr+)
BP

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7
Q

Tx for high BP?
IF asthmatic?
If pre existing?

A

Labetalol
nifedipine (if asthmatic)
if pre existing, stop other antihypertensives

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8
Q

Definitive treatment for high BP?
stable and unstable

A

delivery
stable = 37 weeks
severe = before that

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9
Q

if a patient has a high risk of DVT, 1 high or 2 mod RF, what is given and how much?

A

75-150mg aspirin from 12 weeks - birth
low dose

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10
Q

what is a high dose of aspirin?

A

300mg

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11
Q

What is the physiology of pre eclampsia?

A

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

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12
Q

what is pre eclampsia?

A

more than 20 weeks, hypertension + proteinuria

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13
Q

Other Sx of pre eclampsia?

A

Peripheral oedema
headaches
drowsiness
visual disturbances
epigastric pain
N+V
HYPERREFLEXIA

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14
Q

fetal complications of pre eclampsia?

A

IUGR
Pre term delivery
placental abruption
neonatal hypoxia

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15
Q

maternal complications of pre eclamsia?

A

Eclampsia (seizures due to cerebrovascular vasospasm)
organ failure
DIC
HELLP syndrome

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16
Q

What is given for eclampsia (seizures)?

A

ABCDE
Give MgSO4 IV 4g loading then 1g/h
Corticosteroid
Deliver baby (c section or induced)

17
Q

What do we need to monitor in eclampsia treatment and why?

A

Monitor MgSO4 for Mg toxicity =.BP, RR, DTR

18
Q

SE of magnesium toxicity?

A

sweating, flushing, hypotension, low temp, dizzy

19
Q

what do you give for an MgSO4 overdose?

A

calcium gkuconate

20
Q

What is HELLP syndrome?
What do you see?

A

On bloods you will see Haemolysis, Elevated liver enzymes and Low platelets
High DTR (deep tendon reflex), RUQ pain and N+V

21
Q

Tx for HELLP and when?

A

Deliver baby asap
after 34 weeks NICE

22
Q

What % of pregnancy women suffer from diabetes?

A

2-10%

23
Q

Pre existing affects %?
fetal abnormalities or non?

A

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

24
Q

Gestational affects %?
fetal abnormalities or non?

A

85%
No fetal abnormalities - EXCEPT MACROSOMIA + POLYHYDROMNIOS
related to high hPL + neonatal hypoglycaemia, high risk of DM

25
Q

RF for gestational diabetes?

A

PCOS
Pre exlampsia
htn
obesity
fHx
DM

26
Q

Dx of diabetes? AND RESULTS?

A

OGTT 24-28 weeks (2 readings = Dx) - 5678!!!
FPG >/ 5.6
OGTT 2H >/ 7.7

27
Q

If px has has past med Hx of gest DM, When are they tested for it?

A

test at booking and at 24-28 weeks

28
Q

What are the targets for FPG & OGTT?

A

<5.3 FPG
<6.4 OGTT 2H

29
Q

when the FPG is between 6-6.9 and baby is macrosomic, what is given as treatment?

A

Insulin

30
Q

Treatment for:
FPG /< 7
FPG >/ 7

A

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

31
Q

what needs too be taught to the Px in gest diabetes?
if they have pre existing DM, what should happen?

A

how to monitor BMs
Stop all DM drugs except metformin and insulin

32
Q

What happens to gestational DM treatment postnatally?

A

Stop meds
6-13 weeks gp check hba1C
annual follow up

33
Q

Pre pregnancy investigations for diabetes?

A

Renal - u+E, eGFR, urine, A:Cr
Retinal - fundoscopy

34
Q

Complications of diabetes in pregnancy?

A

polyhydromnios, macrosomia, traumatoic birth, perinatal death, neonatal hypos, 50% Gest DM Turn into T2DM

Phase 3a Obstetrics + sexual health (15 decks)

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