Hypertension in pregnancy Flashcards
25% of antenatal admissions occur as a result of hypertension. true/false?
True
Pre-eclampsia affects what % of primigravida women?
Mild pre-eclampsia affects 10% of primigravida women
Severe pre-eclampsia affects 1% of primigravida women
Meaning of primigravida?
Woman pregnant for the first time
What is pre-eclampsia?
new high blood pressure (hypertension) in pregnancy with end-organ dysfunction, notably with proteinuria (protein in the urine). It occurs after 20 weeks gestation
What cardiovascular changes occur in pregnancy?
Plasma volume
Cardiac output
Stroke volume
Heart rate
peripheral vascular resistance
What is regarded as hypertension in pregnancy?
> / = 140/90 mmHg on 2 occasions, 4 hrs apart
or
> 160/110 mm Hg once
or
A rise of 30/15 mm Hg compared to first trimester
What 3 groups can pregnancy hypertension be grouped into?
Mild
Moderate
Severe
Range for mild hypertension?
Systolic: 140-149 mmHg
and/or
Diastolic: 90-99 mmHg
Range for moderate hypertension?
Systolic: 150-199 mmHg
and/or
Diastolic: 100-109 mmHg
Range for severe hypertension?
Systolic >/= 160mmHg
Diastolic >/= 110mmHg
Types of hypertension that can be present in pregnancy?
pre-existing/chronic hypertension
- Essential
- Secondary
Gestational hypertension (GH)
Pre-eclampsia (PET)
Chronic/pre-existing hypertension features?
- Diagnosis prior to pregnancy
- This is likely if hypertension is present in the first part of pregnancy
- Exists before 20 weeks gestation and is longstanding. Not caused by dysfunction in the placenta and is not classed as pre-eclampsia.
What is essential hypertension?
Aka primary hypertension. High blood pressure with no known cause. It is the most common type and gradually develops over years.
What is secondary hypertension?
high blood pressure that occurs from underlying causes.
Causes can include:
- Cushing’s
- Pheochromocytoma
- Conn’s
- Renal/cardiac
What is gestational hypertension features?
- Presents after 20 week gestation
- NO signs of proteinuria or other features of of pre-eclampsia
- Has better outcomes than pre-eclampsia
- Up to 25 % progression to pre-eclampsia (is dependant on gestation)
- Recurrence rate is HIGH
Main features of pre-eclampsia?
- Hypertension
- Proteinuria (UPCR > 30mg/mmol)
- Oedema
Absence doesn’t exclude diagnosis
Pathogenesis of pre-eclampsia?
- Genetic/environmental pre-disposition
- Stage 1 - abnormal placental perfusion. Placental ischaemia.
- Stage 2 - maternal syndrome - an antiangiogenic state associated with endothelial dysfunction
What increases risk of pre-eclampsia?
If mother and sister also have pre-eclampsia
High risk factors for pre-eclampsia?
Pre-existing hypertension
Previous hypertension in pregnancy
Existing autoimmune conditions (e.g. systemic lupus erythematosus)
Diabetes
Chronic kidney disease
Moderate risk factors for pre-eclampsia?
Older than 40
BMI > 35
More than 10 years since previous pregnancy
Multiple pregnancy
First pregnancy
Family history of pre-eclampsia
Complication symptoms of pre-eclampsia?
Headache
Visual disturbance or blurriness
Nausea and vomiting
Upper abdominal or epigastric pain (this is due to liver swelling)
Oedema
Reduced urine output
Brisk reflexes
How is diagnosis of pre-eclampsia confirmed?
Systolic blood pressure above 140 mmHg
Diastolic blood pressure above 90 mmHg
PLUS any of:
Proteinuria (1+ or more on urine dipstick)
Organ dysfunction (e.g. raised creatinine, elevated liver enzymes, seizures, thrombocytopenia or haemolytic anaemia)
Placental dysfunction (e.g. fetal growth restriction or abnormal Doppler studies)
How is proteinuria quantified?
Proteinuria can be quantified using:
Urine protein:creatinine ratio (above 30mg/mmol is significant)
Urine albumin:creatinine ratio (above 8mg/mmol is significant)
Medical management of pre-eclampsia?
Labetolol is first-line as an antihypertensive
Nifedipine (modified-release) is commonly used second-line
Methyldopa is used third-line (needs to be stopped within two days of birth)
Intravenous hydralazine may be used as an antihypertensive in critical care in severe pre-eclampsia or eclampsia
IV magnesium sulphate is given during labour and in the 24 hours afterwards to prevent seizures
Fluid restriction is used during labour in severe pre-eclampsia or eclampsia, to avoid fluid overload
