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Repro > Hypertension in Pregnancy > Flashcards

Hypertension in Pregnancy Flashcards

1
Q

What is the most common cause of iatrogenic prematurity?

A

Pre-eclampsia

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2
Q

Does pregnancy cause vasodilatation or vasoconstriction?

A

Vasoconstriction

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3
Q

What happens to blood pressure in early pregnancy?

A

Falls

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4
Q

When is nadir reached?

A

22-24 weeks

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5
Q

What is nadir?

A

Lowest point of deccelaration

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6
Q

When does BP rise and fall after nadir?

A

Steady rise until term
Fall after delivery
Rise at day 3/4 post-natal

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7
Q

What is the diagnosis of hypertension?

A

> _140/90 mmHg on 2 occasions
DBP >110mmHg
ACOG - >30/15mmHg compared to booking BP

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8
Q

What are possible secondary causes of hypertension?

A

Renal
Cardiac
Cushing’s/Conns/Phaeochromocytoma

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9
Q

When does pregnancy induced hypertension (PIH) occur?

A

2nd half of pregnancy

Resolves 6 weeks after delivery

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10
Q

What are the features of pre-eclampsia?

A

Hypertension
Proteinuria (>_0.3g/l or >_0.3g/24hours)
Oedema

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11
Q

What happens in pre-eclampsia?`

A

Diffuse vascular endothelial widespread circulatory disturbance

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12
Q

What happens in stage 1 and stage 2 of pre-eclampsia?

A

Stage 1 - Abnormal placental perfusion

Stage 2 - Maternal syndrome

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13
Q

What generally happens in pre-eclampsia?

A

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

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14
Q

What endothelial activation happens in pre-eclampsia?

A 
Increased capillary permeability
Increased expression of CAM
Increased prothrombotic factors
Increased platelet aggregration
Vasoconstriction
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15
Q

What other bodily systems does pre-eclampsia effect?

A 
CNS
Renal
Hepatic
Haematological
Pulmonary
Cardiovascular 
Placental
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16
Q

What CNS diseases can pre-eclampsia lead to?

A 
Eclampsia
Hypertensive encephalopathy
Intracranial haemorrhage
Cerebral haemorrhage
Cortical blindness
Cranial nerve palsy
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17
Q

What renal disease can pre-eclampsia cause?

A

Decreased 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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18
Q

What liver diseases can pre-eclampsia?

A 
Epigastric/RUQ pain
Abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome
(Haemolysis, Elevated liver enzymes, Low platelets) - high morbidity/mortality
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19
Q

What haematological diseases can be caused by pre-eclampsia?

A 
Decreased plasma volume
Haemo-concentration
Thrombocytopenia
haemolysis
Disseminated intravascular coagulation
20
Q

What cardiac/pulmonary diseases can be caused by pre-eclampsia?

A

Pulmonary oedema –> ARDS - iatrogenic, disorder related
Pulmonary embolus
High mortality

21
Q

What placental disorders can pre-eclampsia cause?

A

Intrauterine growth restriction (IUGR)
Placental abruption
Intrauterine death

22
Q

What symptoms are assoc. with pre-eclampsia?

A 
Headache
Visual disturbance
Epigastric/RUQ pain
Nausea/Vomiting
Rapidly progressive oedema
23
Q

What are signs assoc. with pre-eclampsia?

A 
Hypertension
Proteinuria
Oedema
Abdominal tenderness
Disorientation
SGA
IUD
Hyper-reflexia 
Involuntary movements
Clonus
24
Q

What investigations should be done for suspected pre-eclampsia?

A 
Urea & electrolytes
Serum urate
Liver function tests
Full blood count
Coagulation screen
UPCR
CTG
Ultrasound - biometry, AFI, Doppler
25
Q

What’s the management of pre-eclampsia?

A

Assess risk at booking
Hypertension <20 wks = look for secondary cause
Antinatal screening - BP, urine, MUAD
Treat hypertension
Maternal & fetal surveillance
Timing of delivery
PIH can be managed as O/P in day care unit

26
Q

What are risk factors for pre-eclampsia?

A 
Maternal age - >40 years
maternal BMI - >30
FHx
Parity (1st pregnancy)
Multiple pregnancy
Previous PET
Molar pregnancy/Triploidy
27
Q

What are medical risk factors for pre-eclampsia?

A 
Pre-existing renal disease
Pre-existing hypertension
Diabetes mellitus
Connective tissue disease
Thrombophilias (congenital/acquired)
28
Q

What 6 reasons would make you admit someone with suspected pre-eclampsia?

A
  1. BP >170/110 or >140/90 + proteinuria
  2. Significant symptoms - headache / visual disturbances/ abdominal pain
  3. Abnormal biochemistry
  4. Significant proteinuria
  5. Need for antihypertensive therapy
  6. Signs of fetal compromise
29
Q

How do you assess an inpatient?

A 
Blood pressure - 4 hourly
Urinalysis - daily
Input/Output fluid balance chart
UPCR - proteinuria on urinalysis
Bloods - FBC, U&amp;E's, Urate, LFT's, minimum X2 per week
30
Q

How is fetal surveillance carried out?

A

Fetal movements
CTG - daily
Ultrasound - Biometry, amniotic fluid index, umbilical artery doppler

31
Q

When should you deliver?

A

Mother must firstly be stabilised
Consider management if pre-term
Most women deliver within 2 weeks of diagnosis

32
Q

What are indications for delivery?

A 
Term gestation
Inability to control BP
Rapidly deteriorating biochemistry/haematology
Eclampsia
Other crisis
Fetal compromise - REDF, abnormal CTG
33
Q

What are crises in pre-eclampsia?

A 
Eclampsia
HELLP syndrome
Pulmonary oedema
Placental abruption
Cerebral haemorrhage
Cortical blindness
DIC
Acute renal failure
Hepatic rupture
34
Q

What benefit do the steroids have towards the fetus?

A

Promote fetal lung surfactant production

Reduces neonatal respiratory distress syndrome by up to 50%

35
Q

When should steroids be administered?

A

24-48hrs before delivery

36
Q

When can be steroids be administered by?

A

36 weeks gestation

37
Q

What steroid is preferred?

A

betamethasone (2X 12mg injections 12hrs apart)

38
Q

What happens in eclampsia?

A

Tonic-clonic (grand mal) seizure occuring with pre-eclampsia features

39
Q

What is eclampsia assoc. with?

A

Ischaemia

Vasospasm

40
Q

What is the management of severe PET / eclampsia?

A

Control BP
Stop/prevent seizures
Fluid balance
Delivery

41
Q

What 2 antihypertensives are used on pregnant women?

A

IV Labetalol

IV Hydralazine

42
Q

What is used as seizure treatment/prophylaxis?

A

magnesium sulphate

43
Q

What doses of magnesium sulphate?

A

Loading dose - 4g IV over 5 mins

Maintenance dose - IV infusion 1g/h

44
Q

If further seizures happen what dose of magnesium sulphate should be given?

A

2g

45
Q

What should be given if seizures are persistent?

A

Diazepam 10mg IV

46
Q

What drug may be beneficial in preventing severe early onset pre-eclampsia?

A

Aspirin

47
Q

When should aspirin be started?

A

Before 12 weeks

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