Hypertension during pregnancy Flashcards
Is hypertension before 20th week of pregnancy considered pregnancy related?
No
Does pregnancy raise or lower BP?
Lowers. So if the pt is hypertensive before 20 weeks, they will be considered not to have hypertension as a result of the pregnancy.
What is gestational hypertension?
Hypertension after the 20 week juncture of the pregnancy
How long does gestational hypertension take to resolve?
It should resolve within 12 weeks of giving birth
If gestational hypertension does not resolve within 12 weeks, then what?
The pt may be considered to have been hypertensive prior to the pregnancy, but that it was masked by the lowering of BP through pregnancy.
What are the more serious types of hypertension during pregnancy?
Preeclampsia & eclampsia
What is pre-eclampsia?
HTN developed after 20 weeks. But with additional features, inc, protein spilling into the urine, or other form of end organ damage.
What is eclampsia?
When a woman with preeclampsia develops seizures. One of the most feared complications of preeclampsia. Greatest risk just before delivery, during labour, and 24 hours after delivery.
What are the side effects of preeclampsia?
HTN. Damage to the endothelial cells makes the vessels leaky, allowing protein to pass into the urine (eg if they affect the supply to the kidneys). Water follows protein into the tissue (Starlings Law) causing edema. Can affect any organ, so whole body signs (headaches, seizures, sight issues, epigastric pain, foetal growth problems). Can also lead to clotting.
What causes preeclampsia?
Abnormal development of the placenta. The blood vessels do not develop properly. The trophoblasts (forming the outer layer of the blastocyst and provide nutrients to the embryo, which become a large part of the placenta - formed during the first stage of pregnancy) infiltrate the spiral arteries that supply the uterus to gain access to the oxygenated blood. The cells invade the decidua. Preeclampsia occurs when the spiral arteries do not adapt properly to allow for the change in blood flow.
What are the effects of preeclampsia?
If the placenta cannot gain access to the arteries, it leads to a poor blood supply to the placenta. The issue worsens as the pregnancy continues.
How does preeclampsia affect the body?
The cells cannot get enough oxygen and release inflammatory molecules into the blood stream (in protest). These factors begin damaging the lining of the blood vessels (endothelial cells). It damages how the cells help the vessels to relax, so they stiffen and lead to hypertension.
Diagnosing preeclampsia
BP over 140/90. Protein in the urine. End organ damage.
Curing preeclampsia
The only true cure is delivery, as the placenta is causing the problems. Usually go ahead if the mother is past 37 weeks. Pre 37 weeks delivery is only usually done if the preeclampsia is severe.
Preventing eclampsia
Every patient with preeclampsia is started on magnesium sulphate, an anti epileptic drug. Given during labour and continued for 24 hours post partum. Hypertension managed throughout pregnancy.
