Hypertension in Pregnancy Flashcards
What is pregnancy associated hypertension?
Chronic hypertension prior, during, and after pregnancy
What are the syndromic features of pre-eclampsia?
Pregnancy induced
- Hypertension
- Proteinuria
- Generalised oedema
- Multisystem dysfunction
What are the diagnostic criteria for pre-eclampsia?
Hypertension - more than 140/90, or more than 30/15 above baseline
Proteinuria - greater than 300mg/24hours
Generalised oedema
What are the DDx for proteinuria in pregnancy?
Artefact - Leukorrhea
UTI
Pre-eclampsia
What is the prevalence of pre-eclampsia?
Mild 5-10%
Severe 1-2%
How do you treat pre-eclampsia?
Delivery of the baby - even if premature
What are the CV complications?
Severe HTN, pulmonary oedema, HF
What are the renal complications?
Oliguria, renal failure
What are the haematological complications?
Haemolysis, thrombocytopaenia, DIC
What are the neurological complications?
Eclampsia, cerebral oedema,
How does pre-eclampsia present?
Usually they’re well
What is the natural history of PE?
Progress can occur over days to week
What are some predisposing factors to pre-eclampsia?
Family history Age extremes First pregnancy New paternity Period of sexual cohabitation, the shorter the worse Assisted reproduction
How does placental size relate to PE?
The larger the placenta the higher the risk
How do you investigate PE?
MATERNAL • Haematological parameters • Renal function • Hepatic function FETAL • Cardiotocography • Ultrasound
What are signs of severity?
Extreme hypertension Headache Papilloedema Visual disturbances Upper abdominal pain Hyper-reflexia Oliguria Worsening proteinuria Thrombocytopaenia Pulmonary oedema Elevated liver enzymes
What are the management principles for pre-eclampsia?
Admission Stabilisation Blood pressure control Seizure prophylaxis Fluid balance Fetal welfare surveillance Multidisciplinary care DELIVERY Third stage management (between delivery of baby and placenta) Postpartum observation Follow-up
What do you give in the third stage to cause uterine contraction in women with pre-eclampsia
Syntocinon
Not ergometrine as this elevates the blood pressure
How do you monitor recovery after delivery?
Look for a diuresis
How do you manage the HTN in pre-eclampsia?
Orals
• Methyldopa
• Labetalol
• Nifedipine
Acute IV HTN reduction
• Hydralazine
• Diazoxide
What is labetalol?
A combined alpha and beta blocker
How is eclampic acute seizures treated/prophylaxis? How is it administered?
MgS04 (50%) via syringe pump 4g bolus over 15 minutes
2g/hr maintenance
Monitor
- serum levels
- reflexes - eclampic patients are hyperreflexic and have clonus
- respiration
- urine output
Continue 24 hours postpartum Antidote CaCl2 (10ml 10% IV)
How are eclampic patients neurologically?
hyperreflexic and have clonus
How do you predict eclampsia seizures?
Reflexes, clonus • Upper abdominal pain • Facial itching • Visual disturbances • Headache • Rapidly increasing blood pressure • Increasing proteinuria
What is the antidote to MgSO4?
CaCl2
How do manage an eclampic fit?
• Protect patient • Protect airway • Control convulsion • Prevent further convulsions • Review maternal and fetal state • Stablise/optimise maternal and fetal state • Expedite delivery
What is the most common cause of a grand mal seizure in pregnancy?
Epilepsy
What is HELLP syndrome?
A version of pre-eclampsia that predominantly effects the liver and haematological system
How do you prevent pre-eclampsia?
Low dose aspirin 75-150mg daily (CLASP Trial)
