HT in pregnancy Flashcards
characteristics of pre eclampsia
- HT BP >140/90 or more than 30/15 over baseline BP
- Proteinuria >300mg in 4hrs
- generalized oedema
epidemiology of pre eclampsia?
1-2 % severe PE 5-10% mild PE cause of: 15% maternal mortality 10% perinatal mortality labour induction cesarean delivery pre-term deliveries
t./f pre eclampsia usually happens in the first trimester in new mothers
F. Usually in second half of pregnancy (end of 2nd, and 3rd trimester). New mothers is true.
what are the potential complications of pre eclampsia?
Maternal complications: "ADHD" Acute renal failure Disseminated intravascular coagulation HELLP syndrome Death (HELLP syndrome – Haemolysis, Elevated Liver enzymes, Low Platelets)
Neurological - eclampsia, cerebral oedema, amaurosis, cerebral hemorrhage
Fetal complications:
- fetal death
- IUGR
- fetal distress
- placental abruption
pre-eclampsia risk factors?
predisposing
- family hx
- age extremes
- 1st pregnancy
- assisted reproduction
- new paternity in multiparous women
- shorter length of sexual cohabitation
medical conditions:
- severe hypertension
- diabetes
- renal disease
- autoimmune disease
- thrombophilia
pregnancy factors:
- multiple pregnancies
- gestational diabetes
- gestational trophoblast disease (hydatidiform mole, gestational trophobloastic neoplasia, placental-site trophoblastic tumour)
- hydrops fetalis
- trisomy 13
if preeclampsia suspected, how should it be investigated?
maternal
- liver function
- renal function
- haematology panel
fetal
- ctg
- u/s
signs of severe pre eclampsia
- headaches
- extreme HT
- papilloedema
- visual disturbance
- upper abdominal pain
- hyper reflexia
- oliguria
- worsening proteinuria
- thrombocytopaenia
- pulmonary oedema
- elevated liver enzymes
principles of managing severe pre eclampsia?
PE is cured by delivery, but not at delivery!
- immediate admission
- stablization
- BP control
- seizure prophylaxis
- fluid balance
- fetal surveillance
- multidisciplinary care
Delivery
- 3rd stage mgmt
- post partum observation
- follow up
options for managing HT in preeclampsia
- methyldopa
- labetalol
- nifedipine
- hydralazine
- diazoxide
seizure prophylaxis/neuronal stablization mgmt for severe pre eclampsia?
MgSO4 (magnesium sulphate) via syringe pump
4g bolus over 15min
2g/hr maintenance
continue 24hrs postpartum
monitor:
- respiration
- reflexes
- serum levels
- urine output
if magnesium sulfate toxicity is detected what is the recourse?
calcium chloride via IV antidote
what is the added benefit of magnesium sulphate prophylaxis to the fetus?
offers fetal neuroprotection (ie from cerebral palsy)
- in women at risk of early pre-term (less than 30 weeks gestation) birth due to pre eclampsia
- *administer as late as 4hrs from birth or at least within 24hrs of expected birth
in setting of preeclampsia/eclampsia which factors would favor vaginal delivery?
- stable BP
- multiparous woman
- ripe cervix
- fetus sufficient growth >1.5kg estimated weight
- cephalic presentation
- normal morphology
- overall satisfactory fetal welfare
in setting of preeclampsia/eclampsia which factors would favor caesarean delivery?
- primiparous mother
- unstable BP control
- cerebral irritability
- unripe cervix
- immature fetus <1.5kg estimated weight
- breach presentation
- fetal IUGR
- abnormal fetal doppler blood flow or abnormal CTG
fun fact:
*****(amount of uterine pressure required to dilate a ripe cervix is thought to be approximately 1600 mm Hg, while the pressure to dilatate an unripe cervix is estimated to be greater than 5 times that, or 10,000 mm Hg.)
sx and signs of imminent eclampsia? name 5
- upper abdo pain
- facial itching
- visual disturbance
- headache
- rapidly increasing BP
- increasing proteinuria
- increeasing hyperreflexia
*15-30% of eclampsia cases occur postpartum
