Hypertension in pregnancy Flashcards
What is cervical excitation
When try to move cervix to either side of ectopic causes pain
Risk factors for HPTN in pregnancy
Nulli-parous
Multiple pregnancy
Molar pregnancy
Diabetes
Renal disease
HPTN
Black ethnicity
Young or older patients
Cercical shock
If cervical dilation parasympathetic innervation - symptoms of shock
Can happen in any proedure to cervix - cils, ERPOC, hysterectomy
Symptoms POC
Blood supply
Symptoms of PET
Headache, visual disturbances, nausea, vomiting, epigstric pain, restlessness, decreased urine output, oedema. Abdominal pain, bleeding/ leaking per vaginum, contractions, decreased fetal movements
Normal size for the uterus
7.6cm x 4.5cm x 3cm
What is recurrnet miscarriage
> 3 miscarriages one after the other in the same couple
Examination for HPTN in pregnancy
MEWS
BP
urine protein on dipstick
General exam, tenderness in abdomen, reflexes
Urine dips stick/MSU/PCR
FBC, U&E, LFT Clotting, G&S.
What do in abdo exam
Fundal height
Lie
Presentation
Abdo or uterine tenderness
CTG
Management plan for woman with BP 155/100 and protein uria ++
Admit In antenatal ward and observe for 24 hrs if raised BP and proteinuria .
Monitor BP, urine output, biochemistry
fetal growth and well being.
Steroids for fetal lung maturity if delivery is considered within 7 days.
Oral anti-hypertensive -labetolol/methyl-dopa /nifedipine.
What do if develope headahce and epigastric pain in pregnant woman?
Urgent review in ANW within 24 hours
Features of severe pre-eclampsia
BP > 160/110
MAP >25
Hyperreflexia
Rt hypochrondrium tenderness
Uterus relaxed CTG normal
Biochemistry of severe pre eclampsia
Raised urea >7
Creatinine - 80
ALT - 70
PLatelets 130
HELLP - haemolysis, elevated liver enzymes, low platelts
What would expect from beta HCG if miscarriage
Half in 48 hours
Management of severe pre-eclampsia
1-Needs intensive monitoring-Transfer to labour ward
2-Close monitoring BP, Urine output, bloods for Hb, platelets, urea,
creatnine, electrolytes, liver enzymes, clotting profile,
3-Urine protein -PCR
4- control BP –intravenous anti-hypertensives, labetolol, hydralazine
5- prevent- eclampsia magnesium sulphate
6- Delivery will be expedited IOL/Caesarean section
7-Fluid restriction to prevent pulmonary oedema
When does beta HCG stop doubling
around 12 weeks
When can see foetus on scan
6-7 weeks
Pathology of pre-eclampsia
Cerebral- auto regulation of cerebral blood flow is disturbed
irritation, oedema, cerebral haemorrhage,
Eyes- retinal detachment, cortical blindness
Headache, visual disturbances, hyper-reflexia,scizures,coma ,
Lungs-Aspiration during eclamptic fit, hypoproteinaemia,reduced colloid oncotic pressures, intravenous crystalloid replacement for blood losses –prone to pulmonary oedema
Cardiac-contracted intravascular volume, generalised vasoconstriction, capillary leak and other reasons-avoid diuretics
Kidney-glomeruloendotheliosis-swelling of capillaries –decreased perfusion and GFR, loss of resistance to angiotensin II.
Liver- HELLP,congestion, sub capsular haemorrhage-hepatic rupture
( haemolysis, elevated liver enzymes, low platelets-)
Haematology- Anaemia, Disseminated intravascular coagulation
Placenta abruption/ intrauterine death
Name 3 causes of increased symphyseal fundal height
Macrosomia, polyhydraminos, high BMI, fibroid uterus
Name 3 causes of reduced symphysis fundal height
IUGR, oligohydraminos, transverse lie
Pregnancy of unknown location (PUL)
When rigth bHCG for pregnancy
no foetus in uterus
What is macrosomia?
large for gestational age
Causes of oblique/transverse lie at term
Placenta previa, lower segmenet fibroid, cephalopelvic disproportion
