Hypertension in pregnancy Flashcards
Blood pressure physiological changes in pregnancy?
Pregnacny–> Vasodilation so falls in early preg
Then increases steadily until term
Definitions of hypertension?
> 140/90 on 2 occasions
DBP>110
> 30/15 compared to booking BP
Types of hypertension in pregnancy?
Pre existing
Pregnancy induced
Pre eclampsia
What is pre eclampsia?
Hypertension + proteinuria
Oedema but absence does not exclude diagnosis
Pathogenesis of pre eclampsia?
Failure of normal vascular remodelling
Spiral arteries failt to become high capacitance, low resistance vessels
Placental ischameia–> endothelial damage
CNS disease resulting from pre eclampsia?
Eclampsia Hypertensive encephalopathy Intracran. haemorrhage Cerebral oedema Cortical blindness Cranial nerve palsy
Renal disease resulting from pre eclampsia?
decrease GFR Proteinuria Increase uric acid Increased creatinine Oliguria AKI
Liver disease resulting from pre eclampsia?
HELLP syndrome
Haemolysis, elevated liver enzymes
Low platelets
Haematological disease resulting from pre eclampsia?
Decreased PV Haemoconcentration Thrombocytopenia Haemolysis Disseminated intravascular coagulation
Cardiac/pulmonary disease resulting from pre eclampsia?
Pulmonary oedema–>ARDS
Embolus
Placental disease resulting from pre eclampsia?
IUGR
Placental abruption
Intrauterine death
Symptoms of pre eclampsia?
Headache Vision disturbance Epigastric/RUQ pain N + V Rapidly progressive oedema
Signs of pre eclampsia?
HTN
Proteinuria
Oedema
Abdo tenderness etc etc
Ix for pre eclampsia?
U=E Urate LFT FBC Coag UPCR CTG US
Medical risk factors of pre eclampsia?
Pre existing renal disease Pre existing HTN DM CTD Thrombophilia
Treatment for Hypertension in pregnancy?
Labetalol- A and B blocker
Methyl dopa- A blocker
Nifedipine- Ca blocker
Hydralazine- Vasodilator
Indications for delivery?
Term Inability to control BP Rapidly deteriorating biochem Eclampsia Fetal compromise
What is eclampsia?
Tonic clonic seizure with features of pre eclampsia
Management of eclampsia?
Control BP
Stop/prevent seizure
Fluid balance
Delivery
Antihypertensives in eclampsia?
IV Labetalol
IV hydralazine
Seizure treatment in eclampsia?
Magnesium sulphate IV
If persistent Diazepam IV
What role does aspirin play in post partum management?
Inhibits COX–> Prevents TXA 2 synthesis
Reduces PET
