Hypertension in Pregnancy Flashcards
what happens to blood pressure in pregnancy
- falls in early pregnancy
- reaches plateau at 22-24 weeks
- rises until term
what happens to bp after delivery
BP falls after delivery but subsequently times and peaks, at day 3-4 P/N
what is the common BP after first trimester
100/80 or 90/60
what cause decrease in BP in early pregnancy
reduced TPR caused by vasodilation
at what point in the pregnancy should normal bp return
34 weeks
what is the definition of HTN in pregnancy
≥140/90 mmHg on 2 occasions
OR
DBP > 110mmHg
OR
> 30/15mmHg increase compared to booking BP
what risks do pre-existing HTN carry in pregnancy
Pre-eclampsia
IUGR
abruption
what are features of PIH
disease of the second half of pregnancy
resolves within 6 weeks of delivery
No proteinuria/oedema or other features of pre-eclampsia
what are features of pre-eclampsia
Hypertension
Proteinuria (≥0.3g/l or ≥0.3g/24h)
Oedema
what is the pathogenesis of pre-eclampsia
Failure of trophoblast invasion reducing blood flow to placenta, as there is decreased placental perfusion, Mother raises blood pressure to compensate
how can pre eclampsia affect the resp system
Pulmonary oedema»_space; ARDS
Pulmonary Embolus
how can pre eclampsia affect the placenta
IUGR
placental abruption
intrauterine death
Sx of pre-eclampsia
headache visual disturbances epigastric/RUQ pain Nausea/vomiting rapidly progressive oedema
risk factors for pre-eclampsia
Maternal Age >40 years Maternal BMI >30 Family History Parity (first pregnancy) Multiple pregnancy (Twins) Previous PET Molar Pregnancy / Triploid
what is the most significant risk factor for developing pre-eclampsia
having previously had pre-eclampsia
what are medical risk factors for developing pre-eclampsia
Pre-existing renal disease Pre-existing hypertension Diabetes Mellitus Connective Tissue Disease Thrombophilias
when should a mother be admitted
BP >170/110 or >140/90 with (++) proteinuria
significant symptoms; headache/visual disturbance/abdominal pain
abnormal biochemistry
significant proteinuria
need for antihypertensive therapy
signs of metal compromise
what BP makes Tx needed
> 150/100
[>170 required immediate Tx]
what drugs need to be avoided in the Tx of HTN in pregnancy
diuretics
ACE inhibitors
what drugs can be used in Tx of HTN
methyldopa
labetolol
nifedipine
what drug is contraindicated in depression
methyldopa
what drug is contraindicated in asthma
labetolol
what is eclampsia
Tonic-clonic seizure occuring with features of pre-eclampsia
what age group is eclampsia more common in
teenagers
