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Reproduction > Hypertension in Pregnancy > Flashcards

Hypertension in Pregnancy Flashcards

1
Q

How common is eclampsia

A

1/2000 pregnancies affected

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2
Q

What happens to the blood vessels in pregnancy

A

vasodilation

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3
Q

What happens to the BP in early pregnancy

A

falls with lowest point at 22-24 wks

slowly rises until term

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4
Q

What happens to BP after delivery

A

falls but subsequently rises and peaks at 3-4 days post natal

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5
Q

How is hypertension diagnosed in pregnancy

A

more than 140/90 on 2 occasions
DBP more than 110
according to ACOG - rise of more than 30/15 compared to booking BP = hypertension

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6
Q

what are the three categories of hypertension in pregnancy

A 
pre existing (first half)
pregnancy induced (second half)
pre eclampsia (usually ins econd half)
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7
Q

What are the possible risks of hypertension in pregnancy

A

PET
IUGR
Abruption

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8
Q

What are the features of PIH

A 
Second half of pregnancy
Resolves within 6 wks post partum
No proteinuria
Some progress to pre eclampsia
High recurrence rate
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9
Q

What are the defining features of pre eclampsia

A

Hypertension
Proteinuria
Oedema

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10
Q

What is the pathogenesis of pre eclampsia

A

Genetic predisposition

Two stages: abnormal placental perfusion and maternal syndrome

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11
Q

What medications can be used to treat hypertension in pregnancy

A
  1. Labetalol
  2. Methyldopa
  3. Nifedipine ( if monotherapy fails)
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12
Q

What hypertensive medications need to be stopped in pregnancy

A

ACE inhibitors and ARBs ‘sartans’

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13
Q

How is severe hypertension treated eg 165/110

A

Labetalol oral or IV
Hydralazine
Nifedipine

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14
Q

What is the target BP in pregnancy

A

Aim fro less than 150/80-100
If there is organ damage er proteinuria, aim for 140/90
less than 140/90 consider reducing dose
If less than 130/90 reduce dose

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15
Q

When should the baby be delivered in pre eclampsia

A

37 weeks

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16
Q

Describe the pathogenesis of pre-eclampsia

A

Abnormal placentation and trophoblast invasion –> failure of normal vascular remodelling
Spiral arteries fail to adapt to become high capacitance, low resistance vessels
Placental ischaemia –> widespread endothelial damage and dysfunction

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17
Q

What CNS problems can occur due to hypertension in pregnancy

A 
eclampsia
hypertensive encephalopathy
Intracranial haemorrhage
Cerebral oedema
cortical blindness
cranial nerve palsy
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18
Q

What renal disease may occur due to hypertension in pregnancy

A 
increased GFR
Proteinuria
increased serum uric acid (also placental ischaemia)
increased creatinine / potassium / urea
Oliguria /anuria
Acute renal failure
acute tubular necrosis
renal cortical necrosis
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19
Q

What lifethreatening liver disease can occur due to pre-eclampsia/ high BP in pregnancy

A

HELLP syndrome

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20
Q

What dies HELLP syndrome stand for

A

Haemolysis
Elevated Liver enzymes
Low Platelets

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21
Q

What haematological conditions can occur due to high BP

A

decreased plasma volumeHaemo-concentration
Thrombocytopenia
Haemolysis
Disseminated Intravascular Coagulation

22
Q

What CVS/lung disease can occur due to high BP in pregnancy

A

PE

Pulmonary oedema –> ARDS

23
Q

What else is there an increased risk of in pregnancies with hypertension

A

IUGR due to placental insufficiency
Placental abruption
IUD

24
Q

What are the symptoms of pre eclampsia

A 
Headache
Visual disturbance
Epigastric /RUQ pain
Nausea and vomiting
Oedema which is rapidly progressing
25
Q

What signs may be present in pre eclampsia

A 
Hypertension
Proteinuria
Oedema
Abdominal tenderness
Disorientation
Small for gestational age
IUD
Hyper-reflexia / involuntary movements / clonus
26
Q

What are the risk factors for preeclampsia

A 
Maternal Age (>40 years 2X)
Maternal BMI (>30 2X) 
Family History (20-25% if mother affected, up to 40% if sister)
Parity (first pregnancy 2-3X)
Multiple pregnancy (Twins 2X)
Previous PET (7X)
Molar Pregnancy / Triploidy

Multiparous women develop more severe disease

27
Q

What medical conditions make a woman more at risk of pre eclampsia

A 
Pre-existing renal disease
Pre-existing hypertension
Diabetes Mellitus
Connective Tissue Disease
Thrombophilias (congenital / acquired
28
Q

What test can be done to predict pre eclampsia and at what gestation

A

Maternal uterine artery Doppler

20-24 weeks

29
Q

When would you admit a woman with pre eclampsia

A

BP >170/110 OR >140/90 with (++) proteinuria

Significant symptoms - headache / visual disturbance / abdominal pain

Abnormal biochemistry

Significant proteinuria - UPCR >30mg/mmol

Need for antihypertensive therapy

Signs of fetal compromise

30
Q

How are in patients with pre eclampsia assessed

A

Blood Pressure - 4 hourly

Urinalysis - daily

Input / output fluid balance chart

UPCR - if proteinuria on urinalysis

Bloods - FBC, U&Es, Urate, LFTs. Minimum X2 per week

31
Q

How is the fetus monitored in fetal surveillance

A

Fetal Movements

CTG - daily

Ultrasound
Biometry
Amniotic Fluid Index
Umbilical Artery Doppler

32
Q

At what MAP is there a significant risk of cerebral haemorrhage

A

more than 150mmHg

33
Q

When should you treat hypertension in pregnancy

A

if BP more than 150/100

34
Q

How is MAP calculated

A

(2x diastolic + systolic) /3

35
Q

What is the mechanism of action of methyldopa

A

centrally acting alpha agonists

36
Q

Mechanism of action of labetalol

A

alpha and beta agonist

37
Q

Mechanism of action of nifedipine

A

calcium channel antagonist

38
Q

Mechanism of action of hydralzine

A

vasodilator

39
Q

Contraindications of methyldopa

A

depression

40
Q

contraindications of labetalol

41
Q

What is the cure for pre eclampsia

A

deliver baby

42
Q

What would be indications for delivery

A 
Term gestation
Inability to control BP
Rapidly deteriorating biochemistry / haematology
Eclampsia
Other Crisis
Fetal Compromise - REDF, abnormal CTG
43
Q

List crises in pre eclampsia

A 
Eclampsia
HELLP syndrome
Pulmonary Oedema
Placental Abruption
Cerebral Haemorrhage
Cortical Blindness
DIC
Acute Renal Failure
Hepatic Rupture
44
Q

What is eclampsia

A

Grand mall seizure with symptoms/features of pre eclampsia

45
Q

when does most eclampsia occur

A

post partum

46
Q

what age group is eclampsia more common in

47
Q

What are the four principles of managing severe PET/eclampsia

A

control bp
stop/prevent seizures
fluid balance
delivery

48
Q

What is given for seizure treatment /prophylaxiz

A

magnesium sulphate 4g IV over five mins
maintain with IV infustion 1g/h
if further seizures admister 2g Mg sulphate
If persistant consider diazepam,

49
Q

what is the main cause of death in pre eclampsia

A

pulmonary oedema

50
Q

What should be given with caution in pts with preeclampsia or eclampsua

A

IV fluids - safer to run patient dry

51
Q

When is low dose aspirin given

A

high risk women (previous PET etc)
best at preventing severe early onset pre eclampsia
commence before 12 weeks

Reproduction (52 decks)

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