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Hugh's MD3 Women's > Hypertension in Pregnancy > Flashcards

Hypertension in Pregnancy Flashcards

1
Q

What is pregnancy associated hypertension?

A

Chronic hypertension prior, during, and after pregnancy

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2
Q

What are the syndromic features of pre-eclampsia?

A

Pregnancy induced

  • Hypertension
  • Proteinuria
  • Generalised oedema
  • Multisystem dysfunction
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3
Q

What are the diagnostic criteria for pre-eclampsia?

A

Hypertension - more than 140/90, or more than 30/15 above baseline
Proteinuria - greater than 300mg/24hours
Generalised oedema

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4
Q

What are the DDx for proteinuria in pregnancy?

A

Artefact - Leukorrhea
UTI
Pre-eclampsia

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5
Q

What is the prevalence of pre-eclampsia?

A

Mild 5-10%

Severe 1-2%

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6
Q

How do you treat pre-eclampsia?

A

Delivery of the baby - even if premature

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7
Q

What are the CV complications?

A

Severe HTN, pulmonary oedema, HF

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8
Q

What are the renal complications?

A

Oliguria, renal failure

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9
Q

What are the haematological complications?

A

Haemolysis, thrombocytopaenia, DIC

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10
Q

What are the neurological complications?

A

Eclampsia, cerebral oedema,

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11
Q

How does pre-eclampsia present?

A

Usually they’re well

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12
Q

What is the natural history of PE?

A

Progress can occur over days to week

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13
Q

What are some predisposing factors to pre-eclampsia?

A 
Family history
Age extremes
First pregnancy
New paternity
Period of sexual cohabitation, the shorter the worse
Assisted reproduction
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14
Q

How does placental size relate to PE?

A

The larger the placenta the higher the risk

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15
Q

How do you investigate PE?

A 
MATERNAL
• Haematological parameters
• Renal function
• Hepatic function
FETAL
• Cardiotocography
• Ultrasound
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16
Q

What are signs of severity?

A 
Extreme hypertension 
Headache 
Papilloedema 
Visual disturbances 
Upper abdominal pain 
Hyper-reflexia 
Oliguria 
Worsening proteinuria 
Thrombocytopaenia 
Pulmonary oedema 
Elevated liver enzymes
17
Q

What are the management principles for pre-eclampsia?

A 
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
18
Q

What do you give in the third stage to cause uterine contraction in women with pre-eclampsia

A

Syntocinon

Not ergometrine as this elevates the blood pressure

19
Q

How do you monitor recovery after delivery?

A

Look for a diuresis

20
Q

How do you manage the HTN in pre-eclampsia?

A

Orals
• Methyldopa
• Labetalol
• Nifedipine

Acute IV HTN reduction
• Hydralazine
• Diazoxide

21
Q

What is labetalol?

A

A combined alpha and beta blocker

22
Q

How is eclampic acute seizures treated/prophylaxis? How is it administered?

A

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)

23
Q

How are eclampic patients neurologically?

A

hyperreflexic and have clonus

24
Q

How do you predict eclampsia seizures?

A 
Reflexes, clonus
• Upper abdominal pain
• Facial itching
• Visual disturbances
• Headache
• Rapidly increasing blood pressure
• Increasing proteinuria
25
Q

What is the antidote to MgSO4?

A

CaCl2

26
Q

How do manage an eclampic fit?

A 
• Protect patient
• Protect airway
• Control convulsion
• Prevent further convulsions
• Review maternal and fetal state
• Stablise/optimise maternal
and fetal state
• Expedite delivery
27
Q

What is the most common cause of a grand mal seizure in pregnancy?

A

Epilepsy

28
Q

What is HELLP syndrome?

A

A version of pre-eclampsia that predominantly effects the liver and haematological system

29
Q

How do you prevent pre-eclampsia?

A

Low dose aspirin 75-150mg daily (CLASP Trial)

Hugh's MD3 Women's (68 decks)

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