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Repro > Hypertension in pregnancy > Flashcards

Hypertension in pregnancy Flashcards

1
Q

hypertension affects how many pregnancies

A

10-15%

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2
Q

what happens to blood pressure in early pregnancy

A

falls

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3
Q

what happens after the fall in BP

A

slowly rises until term after 22-23 weeks

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4
Q

what happens to BP after delivery

A

falls after
rises and peaks at day 3-4
can rise again till day 10 and then will usually return to pre pregnancy levels

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5
Q

hypertension values

A

> =140/90 on two occasions

DBP>110

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6
Q

pre existing hypertension when is it likely

A

if hypertension during early pregnancy as blood pressure should fall during this period

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7
Q

when will it be pre existing hypertension after delivery

A

if still present 3 months after delivery

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8
Q

what secondary causes should be considered when hypertension is present

A 
renal - do renal US
cardiac - echo
cushings
conns
phaemochromocytoma  TFTs
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9
Q 
PIH when dx
when does it resolve
signs
progression 
recurrence
A 
second half of the preg
6 weeks of delivery
no proteinuria or other signs of PET
15% progress to PET esp in early gestation
rate of recurrence is high
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10
Q

three common signs in PET

A

htn
proteinuria >=0.3/l or >= 0.3/24hours
oedema

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11
Q

what is PET

A

pregnancy specific multi system disorder with unpredictable variable end widespread manifestations

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12
Q

what are the different systems PET can affect

A 
renal
hepatic
cardiovascular 
haem
CNS
placenta
pulmonary
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13
Q

causes for PET

A

genetic usually

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14
Q

stages of PET

A

STAGE 1 abnormal placental perfusion in early pregnancy

STAGE 2 maternal syndrome

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15
Q

what is the pathogenesis for placentation

A

takes place in the first 20 weeks pf pregnancy
trophpblast invasion on the walls of the spinal artery which takes away the muscle layer around the artery going towards the decidua
this causes the spinal arteries to dilate and increases the blood flow to the placenta

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16
Q

what happens in PET associate with placentation

A

failure of trophoblastic invasion leading to low capacity high resistant circulation of blood
less blood goes to the placenta so the mother increases her blood pressure to try and compensate
this leads to endometrial damage leading to placental infarction causing further endometrial damage - in the second half of pregnancy this is manifested as PET

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17
Q

CNS disease in PET

A 
eclampsia
hypertensive encephalopathy - confusion
intracranial haemorrhage 
cerebral oedema 
corticol blindeness - occipital ischemia 
cranial nerve palsy 
in extreme forms can lead to a seizure
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18
Q

renal disease in PET

A 
decrease GFR
proteinuria
increased serum acid (also can be due to placental iscaemia)
increased creatinine/k/urea
oliguria/anuria
acute renal failure
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19
Q

urate level above what is always abnormal for a pregnancy woman

A

0.4

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20
Q

liver disease in PET

A

epigastric/RUQ pain
abnormal liver enzymes
hepatic capsule rupture

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21
Q

what is HELLP syndrome

what does it have

A

variant of eclampsia

haemolysis
elevated liver enzymes
low
platelets

high morbidity/mortality

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22
Q

haematological disease in PET

A 
decrease in plasma volume
ahem concentration 
thrombocytopenia
haemolysis
disseminated intravascular coagulation
23
Q

cardiac/pulmonary disease in PET

A

pulmonary oedema leads to ARDS which is usually iatrogenic due to fluid intake

PE - leading cause of maternal mortality

24
Q

placental disease in PET

A

IUGR
placental abruption

both can potentially lead to intra uterine death

25
Q

symptoms in PET

A 
headache - CNS
visual disturbance - CNS
epigastric/RUQ pain - liver
N/V - liver
rapidly progressing oedema
26
Q

signs in PET

A 
htn
proteinuria
oedema
abdominal tenderness/uterine tenderness
disorientation due to encephalopathy 
SGA
intra uterine death
hyper flexia/involuntary movements/clonus
27
Q

investigations in PET

A 
U&Es
serum urate
LFTs
FBC
coag screen
urinary protein creat ratio
CTG
US - biometry, AFI, doppler
28
Q

management of PET

A

assess risk at booking
if htn present <20 weeks look for secondary cause
at antenatal screening - BP, urine, maternal uterine artery doppler
treat hypertension
maternal and fetal surveillance

29
Q

risk factors for PET

A 
maternal age >40 doubles risk
maternal BMI >30 doubles risk 
FH 20-25% if mum affected 40% if sister
first preg 2-3x risk
multiple pregnancy 2x risk
previous PET 7x risk
molar pregnancy/triploidy
30
Q

when is PET worse

A

when it is in the consecutive pregnancies and the first preg was fine - tends to be more severe

31
Q

medical risk factors for PET

A 
renal disease
hypertension 
DM
CTD - esp anti phospho synd
thrombophillia
32
Q

maternal uterine artery doppler when is it done

what does it assess and abnormalities

A

20-24 weeks with the fetal anomaly scan

normal result is high resistance vessels going to low resistance vessels
abnormal - high resistance - notch present

33
Q

when should a px be referred to antenatal day care unit

how many of these women will be admitted

A

BP >=140-90
proteinuria ++
oedema present
symptoms such as persistent headache

for 1000 20

34
Q

when should a px be admitted

A

BP >170/110 or >140/90 with proteinuria ++
significant symptoms - headache, visual disturbance, abdominal pain
abnormal biochem
significant proteinuria UPCR >30
need for anti hypertensives
signs of fetal compromise

35
Q

inpatient assessment - what is done

A 
blood pressure - 4 hourly 
urinalysis - daily 
input/output fluid chart
UPCR if proteinuria on urinalysis
bloods - FBC, UandEs, LFTs min twice weekly
36
Q

fetal surveillance

A

fetal movements
CTG done daily
US if no result on CTG - amniotic, biometry, umbilical artery doppler

37
Q

umbilical artery doppler

A

can be used for someone who already has PET or IUGR

blood sent to the mum from the baby

38
Q

treatment of hypertension when

A

> =150/100

BP >=170/110 requires immediate treatment

39
Q

wat can happen with MAP >=150

A

significant risk of cerebral haemorrhage

40
Q

aim in BP

A

140-150/90-100

41
Q

1st line in treatment of ht
2nd line
3rd line

A

labetalol
nifedipine
hydrazine IV for women with asthma who can’t tolerate nifedipine

42
Q

what should be given before delivering the baby

A

steroids - 12mg of dexa IM given at 4 or 12 hour intervals

43
Q

indications for delivery

A 
term gestations
inability to control BP
rapidly deteriorating biochem/haemo
PET
other crisis 
fetal crisis - REDF, abnormal CTG
44
Q

crises in PET

A 
eclampsia
HELLP
pulmonary oedema
placental abruption
cerebral haemorrhage 
corticol blindeness
DIC
acute renal failure
hepatic failure
45
Q

what do steroids do

A

promote fetal lung surfactant production

decrease neonatal respiratory distress syndrome by up to 50% if administered 24-48 hours before delivery

46
Q

eclampsia seizure

A

tonic clonic occurs before features of PET
>1/3 will have one before the onset of htn/proteinuria
most common in teenagers
assoc with ischaemia/cerebral vasopasm

47
Q

when do most seizures occur

A

in labour or after

48
Q

management of severe PET/ecmlapsia

A

control BP - IV labetalol, IV hydralazine
stop/prevent seizures
fluid balance
delivery

49
Q

seizure management/prophylaxis

A

Mg sulphate 4g IV over 5 mins
maintenance dose IV infusion 1g/h
if further seizures then 2mg mg sulphate
if persistent then diazepam 10mg IV

50
Q

how much fluid an hour

A

80ml

51
Q

treatment of oliguria following delivery

A

does not require intervention
common
happens to 30% of women

52
Q

what should be avoided in labour

A

ergometrine as it causes maternal hypertension - just use syntocin

53
Q

dose of aspirin given and why and to who

A

75mg
prevents PET
given to anyone with risk factors for PET

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