HT in pregnancy Flashcards
HT in pregnancy can be split into how many categories?
3
Pre-existing
Gestational/pregnancy induced
Pre-eclampsia
What is HT defined as in pregnancy?
BP>140/90 on 2 occasions OR 160/110 on 1 occasion OR >30/15 mmHg compared to 1st trimester BP
What is the likely diagnosis if HT is present in early pregnancy and why?
Pre-existing HT
Because these diseases are usually of 2nd half of pregnancy if that is the cause
What does PE HT increase risk of?
Pre-eclampsia
Intra-uterine growth
Restriction
Abruption
What HT drugs are Teratogenic and should be stopped?
ACEis
ARBs
Diuretics
First line HT therapy during pregnancy?
Oral labetalol
What is orla labetalol?
Joint alpha and beta blocker
2nd line agents for HT in pregnancy?
Methyldopa
Nifedipine
Women who are at mod-high risk of -re-eclampsia should be given what and for how long/when?
Aspirin from 12 weeks until birth if moderate or high risk
Are HT drugs safe for breast feeding?
Yes- well some are
ACEi, B blockers and nifedipine are all safe
Methyldopa should be avoided
What drug should be avoided in Breast feeding and why?
Methyldopa
Risk of depression
Definition of gestational HT?
BP> 140/90mmHg after 20 weeks gestation in previously normotensive woman
When does gestational HT normally resolve?
6 weeks after delivery
Are there any other features accompanying gestational HT?
NO features of pre-eclampsia (Proteinuria)
although 15% do progress to pre-eclampsia
Rate of gestational HT recurrence?
High
Blood tests for gestational HT?
-FBC U&Es -Serum creatinine -Calcium -Liver biochem -LFTs
What should be tested for in urine in gestational HT?
Urine tests for protein to check for pre-eclampsia
Mod gestational HT treated with?
Oral labetalol
When would a woman need admitted to hospital in gestational HT?
BP>160/110
What is pre-eclampsia?
Condition seen after 20 weeks of pregnancy characterized by pregnancy induced HT and proteinuria and oedema
Pathogenesis of pre-eclampsia?
- Thought to be multifactorial (genetic&environment)
- Stage 1: abnormal placental perfusion
- Stage 2: maternal syndrome where mother responds to decreased placental perfusion and this = systemic disease
Why does abnormal placental perfusion happen in stage 1 of pre-eclampsia?
Abnormal trophoblastic invasion
Stage 2 causes what of pre-eclampsia?
Systemic disease
RFs for developing pre-eclampsia?
Age >40 BMI> 30 Fam Hx Multiple pregnancy Primiparity Previous Pre-eclamp Long birth interval Molar pregnancy Pre-existing HT Renal disease Diabetes APS RA Sickle cell disease
Presentation of pre-eclampsia? (symptoms)
- Headache
- visual disturbance
- Epigastric pain/RUQ pain
- N&V
- Rapidly progressive oedema
Signs of pre-eclampsia?
HT Proteinuria Oedema Abdo tenderness Disorientation SGA Itra0uterine fetal death Hyper-reflexia/involuntary movements/clonus
Investigations for pre-eclampsia?
U&Es Serum urate LFTs FBCs Coag screen Urine creatinine ration Cardiotocography US Bilateral uterine notching on doppler US= rf for onset of pre-eclamp
What is an investigation finding that is a RF for onset of pre-eclampsia?
Bilateral uterine notching on doppler US
Management of pre-eclampsia when BP=140/90-159-109mmHg?
Admit if clinical concerns of well being
Offer drugs if BP remains above 140/90 (labetalol)
Aim for BP <135/85
BP monitor every 48 hours
Measure FBCs, LFT, Renal function 2 times week
Fetal heart auscultation
US at diagnosis and then every 2 weeks
Treatment of pre-eclampsia where BP is >160/110?
Admit to hospital
Drugs for all women
BP 135/85 or less = target
Monitor BP every 15-35 mins until below 160/110
Measure FBCs, liver function, renal function 3 times a week
Fetal heart auscultation
US at diagnosis then every 2 weeks
Only cure for pre-eclampsia?
Birth
When to deliver baby in a mother with pre-eclampsia?
Most women delivered within 2 weeks of diagnosis
Indications for birth include?
Term gestation Inability to control BP Rapidly deteriorating biochem/haem Eclampsia Fetal compromise on US or CTG
Crises in pre-eclmapsia?
Eclampsia HELLP syndrome Pulmonary syndrome Placental abruption Cerebral haemorrhage Cortical blindness DIC Acute renal failure Hepatic rupture
What is eclampsia?
Tonic clonic seizures occuring with feature of pre-eclampsia
Management of eclampsia?
Control BP with IV labetalol or IV hydralazine
Stop/prevent seizures with magnesium sulphate
Fluid balance (PO= big cause of death therefore run ptnt dry)
Delivery aim for vaginal if possible
What is HELLP Syndrome?
Haemolysis
Elevated liver enzymes
Low platelets
Why is there haemolysis in HELLP syndorme?
Endothelial damage in pre-eclampsia results in formation of tiny thrombi which damage red cells as they circulate
Clinical features of HELLP?
Patients complain of epigastric/RUQ pain, N&V, jaundice
Treatment of HELLP?
Similar to pre-eclampsia
may also be given blood transfusions to treat anaemia and low platelets
If symptoms are severe in HELLP what is advised?
Prompt delivery in patients who are beyond 34 weeks gestation
Secondary prevention of Pre-eclampsia?
Low dose aspirin at 12 weeks gestation to reduce risk
Why would secondary prevention be done>
Done in women with history of pre-eclampsia or risk of factors for pre-eclampsia
