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HTN in pregnancy Flashcards

1
Q

why does BP fall in early pregnancy

A

vasodilatation

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2
Q

definition of HTN in pregnancy

A

> 140/90 mmHg on 2 occasions

>160/110 mmHg on 1 occasion

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3
Q

types of HTN in pregnancy

A

pre-existing HTN
pregnancy induced HTN (PIH)
pre-eclampsia

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4
Q

HTN in the first trimester is most likely to be

A

pre-existing HTN

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5
Q

what are secondary causes of HTN in pregnancy

A

renal/cardiac causes
Cushing’s
Conn’s
phaeochromocytoma

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6
Q

how is PIH istinguised from pre-eclampsia

A

no proteinuria or other features of pre-eclampsia

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7
Q

what is the likelihood of progressing from PIH to pre-eclampsia

A

15%

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8
Q

signs of pre-eclampsia

A

hypertension
proteinuria
oedema
(absence of one doesn’t exclude the diagnosis)

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9
Q

what is pre-eclampsia

A

diffuse vascular endothelial dysfunction widespread circulatory disturbance

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10
Q

which systems are affected by pre-eclampsia

A 
renal
hepatic 
CV
haematology 
CNS
placenta
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11
Q

late vs early pre-eclampsia

A

early onset = <34 weeks

late onset = >34 weeks

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12
Q

more common; late or early onset pre-eclampsia

A

late-onset

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13
Q

which type of pre-eclampsia has higher risks for mother and baby

A

early onset

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14
Q

pathogenesis of pre-eclampsia

A

genetic/environmental predisposition
stage 1 - abnormal placental perfusion
stage 2 - maternal syndrome (anti-angiogenic state associated with endothelial dysfunction)

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15
Q

what is the outcome of trophoblast invasion in normal placentation and how does this differ in pre-eclampsia

A

trophoblasts invade the muscular layer around the spiral artery to reduce vascular resistance and increase blood flow
in pre-aclmapsia there is no trophoblast invasion which results in high-pressure and low blood flow

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16
Q

CNS disease in pre-eclampsia

A 
eclampsia 
hyertensive encephalopathy 
intracranial haemorrhage 
cerebral oedema 
cortical blindness 
cranial nerve palsy
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17
Q

renal disease in pre-eclampsia

A 
decreased GFR
proteinuria 
high serum uric acid
high creatinine/potassium/urea 
oliguria/anuria 
acute renal failure
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18
Q

liver disease in pre-eclampsia

A

epigastric/RUQ pain
abnormal liver enzymes
hepatic capsule rupture
HELLP syndrome

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19
Q

what are characteristics of HELLP syndrome

A

Haemolysis
Elevated Liver enzyme
Low Platelets

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20
Q

haematological disease in pre-eclampsia

A 
decreased plasma volume 
haemorrhage-concentration 
thrombocytopenia 
haemolysis 
DIC
21
Q

cardiorespiratory disease in pre-eclampsia

A

pulmonary oedema –> ARDS
pulmonary embolus
high mortality

22
Q

placental disease in pre-eclampsia

A

fatal growth restriction
placental abruption
intrauterine death

23
Q

symptoms of pre-eclampsia

A 
headache 
visual disturbance 
epigastric/RUQ pain
nausea/vomiting 
rapidly progressive oedema
24
Q

signs of pre=eclampsia

A 
HTN
proteinuria 
oedema 
abdominal tenderness
disorientation 
small for gestational age 
intrauterine death 
hyper-reflexia/involuntary movements/clonus (>2 beats)
25
investigations for pre=eclampsia
``` U&Es serum urate LFTs FBC coag screen urine PCR CTG USS (fetal biometry, AFI, doppler) ```
26
management of pre-eclampsia
``` assess risk at booking HTN <20 weeks (look for secondary cause) antenatal screening (BP, urine, MUAD) treat HTN maternal and fatal surveillance timing of delivery ```
27
what is MUAD
maternal uterine artery doppler studies
28
what is MUAD used for
to determine is placentation has been successful
29
risk factors for pre-eclampsia
``` >40 BMI >30 FHx parity (first pregnancy) multiple pregnancy previous PE birth interval >10 years molar pregnancy/triploidy ```
30
how does parity affect the severity of pre-eclampsia
more likely to happen if primiparous | more severe disease in multiparous women
31
medical risk factors for pre-eclampsia
``` pre-existing renal disease pre-existing HTN diabetes connective tissue disease thrombophilias ```
32
who is low dose aspirin used in
high risk women (renal, DM, aPS, multiple risk factors, previous PET
33
when should low dose aspirin be started
before 12 weeks
34
what dose of aspirin is used in pre-eclampsia prophylaxis
75 mg
35
when to refer to antenatal daycare unit
BP >140/90 proteinuria (++) oedema symptoms (especially persistent headache)
36
when to admit
``` BP >170/110 or >140/90 with ++ proteinuria significant symptoms abnormal biochemistry significant proteinuria >300 mg/24 hours need for antihypertensive therapy signs of fatal compromise ```
37
inpatient assessment
``` blood pressure 4 hourly urinalysis daily input/output fluid balance urine PCR bloods ```
38
treatment of HTN
aim for 140-150/90-100 mmHg first line labetolol second line nifedipine 3rd line methyl dopa
39
what is labetolol
alpha nad beta agonist | NO ASTHMA
40
what is nifedipine
Ca channel agonist
41
what is methyl dopa
centrally acting alpha blocker
42
why might pregnancy antihypertensive therapy might be poorly tolerated
labetolol - asthma methyl-dopa - depression nifedipine - headache
43
indications for birth
``` term gestation inability to control BP rapidly deteriorating biochemistry/haematology eclampsia other crisis fetal compromise ```
44
crises in pre-eclampsia
``` eclampsia HELLP syndrome pulmonary oedema placental abruption cerebral haemorrhage cortical blindness DIC acute renal failure hepatic rupture ```
45
what is eclampsia
tonic-clonic (grand mal) seizure occurring with features of pre-eclampsia
46
management of severe PET/eclampsia
control BP stop/prevent seizures fluid balance delivery
47
management of seizures in pregnancy
magnesium sulphate
48
post-partum management of eclampsia
``` breast-feeding contraception BP management counselling future risk long term CVD risk ```

3 REPRO (40 decks)

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