Hypertension in Pregnancy Flashcards
What is the most common cause of Iatrogenic prematurity?
Pre-eclampsia
Increase or Decrease during Pregnancy?
- Plasma Volume, CO, SV, HR, PVR?
All increase apart from PVR which decreases
What are the definitions of Hypertension in Pregnancy?
≥140/90 mmHg on 2 occasions , 4 hrs apart.
> 160/110 mmHg once.
What are the different types of Hypertension occurring in Pregnancy?
Pre-existing / chronic Hypertension.
- Essential
- Secondary
Gestational Hypertension
Pre-eclampsia (PET)
When do the different types of Hypertension occur in Pregnancy?
Chronic hypertension more likely in early pregnancy.
GH / PET are diseases of second half of pregnancy.
What secondary causes of chronic hypertension should be considered?
Renal / Cardiac, Cushing’s, Conn’s, Phaeochromocytoma.
What are some of the risks of having Chronic Hypertension in Pregnancy?
PET (x 2 risk), Fetal growth Restriction (FGR) and Abruption.
What can be done to mitigate effects of Chronic Hypertension in early pregnancy?
Discuss alternatives to ACEi / ARB / Thiazide diuretics. Stop within 2 days.
How fast should GH resolve after delivery?
Within 6 weeks
What features of Pre-eclampsia does GH share.
No features (nausea, seizures or proteinuria), Better outcomes.
What percentage of GH progress to pre-eclampsia?
25% progress to PET - it depends on the gestation.
How is GH and Chronic Hypertension managed at birth and Postnatally?
Birth usually >37wks (unless poorly controlled hypertension).
Monitor mothers BP daily after birth.
Target BP <140/90 mmHg.
Stop Methyl Dopa within 2 days.
Continue antihypertensives with review 2 wks post natal and 6-8 wks.
What is the Definition of Pre-eclampsia?
A Pregnancy-Specific multi-system disorder with unpredictable, variable and widespread manifestations.
What happens in Pre-eclampsia?
Diffuse vascular endothelial dysfunction causing widespread circulatory disturbance.
Pre-eclampsia until proven otherwise?
Pre-eclampsia is the onset of New Hypertension after 20 wks with significant proteinuria (UPCR >30mg/mmol)
- Presents with Oedema too.
What is the Classification of Early PET?
<34 weeks.
- Uncommon
- Assoc w extensive villous and vascular lesions of the placenta.
- Higher risk of foetal and maternal complications than late PET.
What is the Classification of Late PET?
≥ 34 weeks,
- Majority of cases (88%)
- Minimal Placental lesions.
- Maternal factors (e.g. metabolic syndrome) have important roles.
- Most cases of eclampsia and maternal death occur in late disease.
What is the Pathogenesis of PET?
An injured placenta releases factors into the maternal circulation that induce PET.
R.Factors for an Injured Placenta include Genetic and Environmental components which create conditions leading to defective deep placentation.
Severity of PET
The Severity and timing of the anti-angiogenic state, as well as maternal susceptibility, might determine the clinical presentation of pre-eclampsia.
What is the overall pathogenesis of PET in stages?
Genetic / Environmental Predisposition.
Stage 1 - Abnormal Placental perfusion (placental ischaemia)
Stage 2 - Maternal Syndrome.
- An anti-angiogenic sate assoc. w endothelial dysfunction.
How does endothelial Dysfunction occur in PET?
Abnormal placentation and trophoblast invasion > Failure of normal vascular remodelling.
Spiral arteries fail to adapt (become high capacity + Low resistance vessels) > Placental Ischaemia > Widespread endothelial damage.
What does PET do to the Hepatic System?
- Epigastric / RUQ pain.
- Abnormal Liver enzymes, (- ALT > 150 assoc with increased morbidity)
- Hepatic capsule Rupture.
- HELLP syndrome.
What is HELLP syndrome?
Haemolysis, Elevated Liver enzymes, Low Platelets.
(High Morbidity / Mortality)
What are the Symptoms assoc with PET?
Headache, Visual Disturbance, Epigastric/RUQ pain, Nausea and Vomiting, Rapidly progressive oedema.
Considerable variation in timing, progression and order of symptoms.
