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Reproduction > Hypertension in Pregnancy > Flashcards

Hypertension in Pregnancy Flashcards

1
Q

What is the commonest cause of iatrogenic prematurity?

A

pre-eclampsia

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2
Q

When do most of the CVS changes in pregnnacy occur?

A

first trimester

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3
Q

What is blood pressure proportional to?

A

systemic vascular resistance and cardiac output

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4
Q

What happens to BP in the first trimester?

A

falls

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5
Q

When does BP drop to its lowest in pregnnacy?

A

22-24 weeks

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6
Q

What is normal BP in early pregnancy?

A

90-100/50-60

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7
Q

When does BP return to normal post-partum?

A

6 weeks

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8
Q

What is hypertension in pregnnacy defined as?

A

> =140/90 on 2 occasions; >160/110 once

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9
Q

What are the 3 types of hypertension in pregnnacy?

A

pre-existing HT; pregnnacy induced HT; pre-eclampsia

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10
Q

What makes pre-existing HT likely diagnosis in pregnnacy?

A

if HT in early pregnnacy

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11
Q

When does PET and PIH tend to occur in pregnnacy?

A

second half f pregnnacy

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12
Q

What are the risks of pre-existing HT in pregnancy?

A

PET; IUGR and abruption

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13
Q

When does PIH resolve?

A

within 6/52 od delivery

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14
Q

What is the typical triad of symptoms seen with pre-eclampsia?

A

HT; proteinuria; oedema

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15
Q

What is proteinuria defined as?

A

> =0.3g/L or >=0.3g/24h

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16
Q

What is pre-eclampsia?

A

diffuse casvular endothelial dysfunction with widespread circulatory disturbance

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17
Q

What is early pre-eclampsia?

A

<34 weeks

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18
Q

What is late pre-eclampsia?

A

> =34 weeks

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19
Q

Is late or early pre-eclampsia more common?

A

late (almost 90%)

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20
Q

What features of placental dysfunction are found in early pre-eclampsia?

A

extensive villous and vascular lesions of the placenta

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21
Q

What is the difference between outcomes between early and late pre-eclampsia ?

A

early- higher risk of maternal and fetal complications but late has higher rates of eclampsia and maternal death

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22
Q

Which type of pre-eclampsia does maternal factors such as HT and metabolic syndrome play a greater role?

A

late pre-eclampsia

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23
Q

What is stage 1 of pre-eclampsia?

A

abnormal placental perfusion due to failure of trophoblastic invasion- placental ischaemia

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24
Q

What is stage 2 of pre-eclampsia?

A

maternal syndrome- an anti-angiogenic state assoc. with endothelial dysfunction leading to organ involvement

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25
Q

What causes the widespread endothelial dysfunction and damage in pre=eclampsia?

A

injured placenta releases toxins and high resistance of spiral artery causes maternal BP to rise to compensate

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26
Q

What happens when endothelial cells are activated in pre-eclampsia?

A

increased capillary permeability; expression of CAM; prothromotic factors; platelet aggregation and vasoconstriction

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27
Q

What do the cytotrophoblasts not do that causes the problems in pre-eclampsia?

A

do not invade the smooth muscle of the spiral artery so they still have high resistance

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28
Q

What are the effects of pre-eclampsia on the CNS?

A

eclampsia; hypertensive encephalopathyl intracranial haemorrhage; cerebral oedema; cortical blindness; CN palsy

29
Q

What renal disease is seen with pre-eclampsia?

A

decreased GFR; proteinuria; increased serum uric acid; creat; K and urea; acute renal failure

30
Q

What liver disease is seen with pre-eclampsia?

A

epigastric/RUQ pain; abnormal liver enzymes; hepatic capusle rutpure; HELLP syndrome

31
Q

What is HELLP syndrome?

A

Haemolysis; elevated liver enzymes and low platelets

32
Q

What haematological disease is seen in pre-eclampsia?

A

decreased plasma volume; thrombocytopenia; haemolysis; disseminated intravascular coagulation

33
Q

What causes pulmonary oedema in pre-eclampsia?

A

iatrogenic- fluid overloaded

34
Q

What can pulmonary oedema lead to?

A

ARDS

35
Q

What placental disease is seen with pre-eclampsia?

A

IUGR; placental abruption; IUD

36
Q

What are the symptoms of pre-eclampsia?

A

HA: visual disturbance; epigastric/ RUQ pain; N and V; rapidly prgressive oedema

37
Q

What are the signs of pre-eclampsia?

A

HT; proteinuria; oedema; abdo tenderness; disorientation; SGA; IUD; hyper-reflexia/ involuntary movements/ clonus

38
Q

What blood level is often the first thing to be elevated in pre-eclampsia?

A

serum urate

39
Q

What investigations should be done for pre-eclampsia?

A

U&Es; serum urate; LFTs; FBC; coag screen; urine PCR; CTG and US

40
Q

What shoudl be done if a woman has HT <20 weeks?

A

look for secondary causes

41
Q

What are hte risk factors for developing pre-eclampsia?

A

> 40 yo; >30 BMI; FHx; nulliparity; multiple pregnnacy; previous PE; birth interval >10 years; molar pregnancy;

42
Q

What are the medical risk factors for devleoping pre-eclampsia?

A

renal disease; HT; diabetes; connective tissue disease; thrombophilias

43
Q

When should low dose aspirin be given for preventing PET?

A

high risk women- renal DM; APS; multiple risk factors prev PET

44
Q

When should low dose aspirin as a preventative be started?

A

before 12 weeks

45
Q

What measurement on USS is used to predict pre-eclampsia?

A

maternal uterine artery doppler

46
Q

When is MUAD done?

A

20-24 weeks

47
Q

When should a woman be admitted with hypertension?

A

BP >170/110 OR >140/90 with ++proteinuria; sgnif symptoms ; abnormal biochemistry; signif proteinurai; need for antihypertensive therapy; signs of fetal compromise

48
Q

How often should BP done as an inpatient?

A

4hrly

49
Q

How often should UA be done as an inpatient?

A

daily

50
Q

What is there a great risk of if MAP >=150

A

cerebral haemorrhage

51
Q

What is the MOA of methyldopa?

A

centrally acting alpha agonist

52
Q

What is the CI for methyldopa?

A

depression

53
Q

What is the MOA of labetolol?

A

alpha and beta antagnoist

54
Q

What is the CI for labetolol?

A

asthma

55
Q

What is the MOA of nifedipine?

A

Ca channel antagonist

56
Q

What is the MOA of hydralazine?

A

vasdilator

57
Q

What is the MOA of doxazocin?

A

alpha antagonist

58
Q

When should doxazocin not be used?

A

in breast feeding

59
Q

What is the only cure for pre-eclampsia?

A

birth

60
Q

What are the indications for birth with pre-eclampsia?

A

term gestation; inability to control BP; rapidly deteriorating biochem; eclampsia; featl compromise

61
Q

What are the crises in pre-eclampsia?

A

eclampsia; HELLP syndrome; po oedema; placental abruption; cerebral haemorrhage; cortical blindness; DIC; acute renal failures; hepatic rupture

62
Q

What is eclampsia?

A

tonic-clonic seizure occuring with features of pre-eclampsia

63
Q

Why is eclampsia difficult to prevent?

A

> 1/3rd will have seizure before onset of HT/proteinuria

64
Q

What age group is eclampsia more common in?

A

teens

65
Q

What drug is used as seizure tx/prophylaxis?

A

magnesium sulphate

66
Q

What drug should be used with persistent seizures?

A

diazepam

67
Q

Why should epidural anaesthesia be recommended in pre-eclampsia/ eclampsia?

A

hypotension and relaxes patient

68
Q

What drug should be avoided during the 3rd atge with eclampsia?

A

ergometrin

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