Hypertension in pregnancy Flashcards
Pre-eclampsia
- Definition
- Presentation
Maternal hypertension and proteinuria in pregnancy from week 20.
- SBP >140
- DBP >90
- 2 separate occasions, >4 hours apart
HELLP syndrome
Syndrome of severe pre-eclampsia
Haemolysis
Elevated liver enzymes
- AST
- ALP is physiologically elevated in pregnancy
Low platelets
- Platelet levels <200
Other organ dysfunctions in pre-eclampsia
Fetal
- IUGR
Investigations in pre-eclampsia
BP
- > 140/90
- Severe= >160/110
FBC
- Haemolysis, platelet count (HELLP)
Urinalysis
- Protein dip 1+
- Albumin: creatinine ratio > 8, protein:creatinine >30
LFTs
- Elevated AST/ALT (>70 IU/L)
Fetal ultrasound
- Monitor fetal growth (IUGR)
High risk factors for pre-eclampsia
Previous pre-eclampsia/ Gestation hypertension
Diabetes
Pre-existing Hypertension
CKD
Autoimmune disease
Eclampsia
- Description
Seizure in pregnancy women due to underlying hypertension.
Management of pre-eclampsia
- High risk
- New diagnosis
High risk
- PO aspirin 150mg from week 12 until birth
- Healthy lifestyle
Blood pressure control, aim 130/90
- Labetalol
- Nifedipine
- Metyldopa
Management of acute eclampsia
Obstetric and paediatric emergency
- ABCDE
- Anticonvulsant: MgSO4
- BP control: IV labetolol (or PO nifedipine/ IV hydralazine)
Fluid restriction
Fetal monitoring after seizure has subsided
Oral corticosteroids is preterm birth is likely
MgSO4 dose during acute eclampsia
- Loading dose= 4g
- Maintenance dose= 1g/Hr
If seizure continuous= bolus dose = 2-4g
First line management of hypertension in pregnancy
Labetalol
Signs/ symptoms of severe pre-eclampia
Symptoms
- Severe Headache
- Visual disturbance: flashing lights,
- LUQ/ epigastric pain
Signs
- Clonus/ brisk reflexe
- papilloedema
Bloods
- Platelets < 100
- Cr >100
- ALT >50
Urine protein:creatine ratio of ______ is significant proteinuria in pre-eclampisa
> 30
24 hour urinary protein of ______ is significant proteinuria for pre-eclampsia
> /= 300
Physiological BP in pregnancy
Falls in first trimester
Stabilises in 2nd
Rises in 3rd
Essential hypertension in pregnancy is likely when…
<20 weeks
- Hypertensive at booking
Most common cause of death in pre-eclampsia/ eclampsia
Intracranial haemorrhage
Maternal complications of DM
- Cerebral
- Respiratory
- RENAL
- Haem
Cerebral
- Seizure, haemorrhage
Pulmonary
- PE, oedema
Renal= AKI
Liver= acute fatty liver of pregnancy
Haem= HELLP
Foetal complications of DM
Placental abruption
Oligohydraminos
IUGR
Risk of HTN and stroke
Vaginal delivery in pre-eclampsia can be considered from..
week 34
Moderate risk factors for pre-eclampsia
Age >40
Family history
- Mother
- Sister
Obesity
- BMI >35
Nulliparous, increased inter-pregnancy (>10 years)
Multiple pregnancy
Birth in pre-eclampsia should be planned when?
At 37 weeks
- Within 24-48 hours
