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3 REPRO > HTN in pregnancy > Flashcards

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
Q

investigations for pre=eclampsia

A 
U&amp;Es
serum urate 
LFTs
FBC
coag screen
urine PCR
CTG
USS (fetal biometry, AFI, doppler)
26
Q

management of pre-eclampsia

A 
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
Q

what is MUAD

A

maternal uterine artery doppler studies

28
Q

what is MUAD used for

A

to determine is placentation has been successful

29
Q

risk factors for pre-eclampsia

A 
>40
BMI >30
FHx
parity (first pregnancy)
multiple pregnancy 
previous PE
birth interval >10 years 
molar pregnancy/triploidy
30
Q

how does parity affect the severity of pre-eclampsia

A

more likely to happen if primiparous

more severe disease in multiparous women

31
Q

medical risk factors for pre-eclampsia

A 
pre-existing renal disease 
pre-existing HTN
diabetes
connective tissue disease 
thrombophilias
32
Q

who is low dose aspirin used in

A

high risk women (renal, DM, aPS, multiple risk factors, previous PET

33
Q

when should low dose aspirin be started

A

before 12 weeks

34
Q

what dose of aspirin is used in pre-eclampsia prophylaxis

A

75 mg

35
Q

when to refer to antenatal daycare unit

A

BP >140/90
proteinuria (++)
oedema
symptoms (especially persistent headache)

36
Q

when to admit

A 
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
Q

inpatient assessment

A 
blood pressure 4 hourly 
urinalysis daily 
input/output fluid balance 
urine PCR
bloods
38
Q

treatment of HTN

A

aim for 140-150/90-100 mmHg
first line labetolol
second line nifedipine
3rd line methyl dopa

39
Q

what is labetolol

A

alpha nad beta agonist

NO ASTHMA

40
Q

what is nifedipine

A

Ca channel agonist

41
Q

what is methyl dopa

A

centrally acting alpha blocker

42
Q

why might pregnancy antihypertensive therapy might be poorly tolerated

A

labetolol - asthma
methyl-dopa - depression
nifedipine - headache

43
Q

indications for birth

A 
term gestation 
inability to control BP
rapidly deteriorating biochemistry/haematology 
eclampsia 
other crisis 
fetal compromise
44
Q

crises in pre-eclampsia

A 
eclampsia 
HELLP syndrome 
pulmonary oedema 
placental abruption 
cerebral haemorrhage 
cortical blindness
DIC
acute renal failure 
hepatic rupture
45
Q

what is eclampsia

A

tonic-clonic (grand mal) seizure occurring with features of pre-eclampsia

46
Q

management of severe PET/eclampsia

A

control BP
stop/prevent seizures
fluid balance
delivery

47
Q

management of seizures in pregnancy

A

magnesium sulphate

48
Q

post-partum management of eclampsia

A 
breast-feeding 
contraception 
BP management 
counselling 
future risk
long term CVD risk

3 REPRO (40 decks)

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