Hypertension in Pregnancy Flashcards
What is hypertension with proteinuria?
Pre-eclampsia
What is the primary defect of pre-eclampsia?
The primary defect is failure of trophoblastic invasion of spiral arteries, leaving them vasoactive
When does pre-eclampsia develops? And when will it resolve?
Pre-eclampsia develops after 20 weeks gestation and usually resolves within 10 days of delivery
What is eclampsia?
Eclampsia occurs when the pregnant mother develops fits
What are the high risk factors of pre-eclampsia?
Diabetes Mellitus, Chronic hypertension, Hypertension in previous pregnancies, chronic kidney disease, autoimmune diseases (SLE, thrombophilia)
What are the moderate risk factors of pre-eclampsia?
first pregnancy, >40yo, FHx of pre-eclampsia, multiple pregnancy
What medication is given to help prevent pre-eclampsia?
Aspirin 75MG OD PO from 12 weeks pregnancy until delivery
Define severe pre-eclampsia.
BP>160/110 with proteinuria, or
BP>140/90 with proteinuria plus Seizures/visual disturbances/headache or epigastric pain/papilloedema
What are the signs and symptoms of pre-eclampsia?
Usually asymptomatic but can present with drowsiness, headache, N&V, epigastric pain/liver tenderness, visual disturbances.
Hypertension is a sign that is absent until later stages.
List the moderate risk factors for pre-eclampsia.
Maternal age >/-40 First pregnancy Multiple pregnancies Family history of pre-eclampsia BMI >/- 35 at time of presentation. 10 years or more since last pregnancy
List the high risk factors for pre-eclampsia.
History of pre-eclampsia, eclampsia or hypertension in previous pregnancies.
Current medical condition: Current hypertension, CKD, DM, autoimmune diseases (SLE, thrombophilia)
What is HELLP syndrome in pre-eclampsia?
HELLP is a mnemonic:
Haemolysis
Elevated Liver enzymes
Low Platelets
What are the complications of pre-eclampsia to the foetus?
Hypoxia
Intrauterine Growth restriction
Preterm birth
Placental abruption
What are the complications of pre-eclampsia on the mother?
Eclampsia - Grand-mal seizures
DIC
Fluid overload, resulting in pulmonary oedema or Acute respiratory distress syndrome
Liver failure or liver rupture
Renal failure
Cerebral haemorrhage: due to failure of autoregulation of cerebral blood flow at mean arterial pressures >140mmHg
HELLP syndrome: Patient presents with N&V, headache and upper right abdominal pain
How is proteinuria determined?
There is proteinuria if it is +2 or more on dipstick, or if there is an increase in more than 0.3g after a 24 hour collection: 0.3g/24hours
OR a Protein: Creatinine Ratio (PCR) or >30mg/mmol
Which anti-hypertensive medication is indicated in pre-eclampsia?
Labetalol (oral/IV),
Nifedipine (only in oral form), alpha-Methyldopa and IV hydralazine.
Who should Labetalol be contraindicated in?
Labetalol is contraindicated in asthmatic patients.
Is smoking protective against pre-eclampsia?
Yes
Define hypertension in pregnancy and pre-eclampsia.
Hypertension in pregnancy is when BP is >140/90mmHg in 2 readings done 4 hours apart.
Pre-eclampsia is defined as new onset hypertension with new onset proteinuria (>0.3g/24 hour)
What is HELLP syndrome?
HELLP Syndrome is a life-threatening liver disorder that develops from severe pre-eclampsia.
H - Haemolysis
EL - Elevated liver enzymes
LP - Low Platelet count
What is Magnesium sulphate used for?
Magnesium sulphate is taken to prevent eclampsia
What reflex is usually done in the examination of patients suspected of pre-eclampsia?
What is the finding from the examination?
Patella reflex.
Hypertension usually results in hyper-reflexia
What are the management steps in those with pre-eclampsia?
Giving MgSO4, anti-hypertensives such as Labetalol, and steroids (betamethasone and dexamethasone)
Why are steroids given?
Steroids are given if it is likely to deliver before 34 weeks.
Steroids helps fetal lung development as it increase surfactant production.
steroids also helps prevent ARDS, decrease risk of bleed in fetal brain and decrease risk of necrotising enterocolitis
Which anti-hypertensive is not suitable for severe eclampsia? Explain.
alpha-Methyldopa, as it is a long-acting anti-hypertensive
When is Labetalol contraindicated?
In pregnant ladies who are asthmatic
What is given if toxicity is suspected after giving Magnesium Sulphate?
10mL of 10% Calcium Gluconate if toxicity is suspected
What medications are avoided antenatally even though it is known to help with lowering BP? Why?
ACE inhibitors and Angiotensin II Receptor antagonists.
ACE inhibitors can cause IUGR and increased incidences of CVS and CNS congenital anomalities.
Angiotensin II receptor antagonists and ACE inhibitors can also cause renal dysfuntion, neonatal anuria, and oligohydramnios.
