Hypertension in pregnancy Flashcards
what happens to BP during pregnancy?
- Blood pressure (BP) proportional to systemic vascular resistance and cardiac output
- Pregnancy à Vasodilatation
- BP falls in early pregnancy
- Nadir reached at 22-24 weeks
- Steady rise until Term
- BP falls after delivery but subsequently rises and peaks at day 3-4 P/N
when would pre-existing hypertension and pregnancy induced hypertension be most likely to be detected?
How long does it normally take for PIH to resolve?
first half for pre-existing
second half for pregnancy induced
6 weeks after delivery
what are the features of pre-eclampsia?
- Hypertension
- Proteinuria (≥0.3g/l or ≥0.3g/24h)
- Oedema
- Absence does not exclude the diagnosis
when to admit for pre-eclampsia
1.BP >170/110 OR >140/90 with (++) proteinuria
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2.Significant symptoms - headache / visual disturbance / abdominal pain
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3.Abnormal biochemistry
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4.Significant proteinuria - UPCR >30mg/mmol
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5.Need for antihypertensive therapy
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6.Signs of fetal compromise
what BP should you aim for with pre eclampsia
- Treat regardless of aetiology
- With MAP ≥150 mmHg there is significant risk of cerebral haemorrhage
- Most treat if BP ≥150/100 mmHg
- BP ≥ 170/110 mmHg requires immediate Rx
- Aim for 140-150/90-100 mmHg
- Control of blood pressure does not reduce the risk of developing pre-eclampsia
what treatment is given for hypertension during pregnancy?
what is the management of eclampsia?
- Control BP
- Stop / Prevent Seizures
- Fluid Balance
- Delivery
what hypertensives are used?
- IV Labetolol
- IV Hydralazine
what is the seizure treatment for eclampsia?
MAGNESIUM SULPHATE
Loading dose: 4g IV over 5 minutes
Maintenance dose: IV infusion 1g/h
If further seizures administer 2g Mg SO4
If persistent seizures consider diazepam 10mg IV
what can be used in high risk cases of pre eclampsia for prophylaxis?
when should it be started?
aspirin
before 12 weeks
