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Reproduction Year 3 > Hypertension in Pregnancy > Flashcards

Hypertension in Pregnancy Flashcards

1
Q

what happens to blood pressure in pregnancy

A

falls in early pregnancy
reaches plateau at 22-24 weeks
Rises until term

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2
Q

what happens to BP after delivery

A

falls after delivery

subsequently rises and peaks at day 3/4 post part

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3
Q

Values for a diagnosis of hypertension

A

> 140/90 mmHg on 2 occaisions

> 160/110 mmHg once

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4
Q

why does BP decrease in early pregnancy

A

reduced TPR (total peripheral resistance) due to vasodilation

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5
Q

risks of pre-existing hypertension in pregnancy

A

Pre-eclampsia
IUGR
Placental abruption

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6
Q

features of pregnancy induced hypertension

A

disease of the second half of pregnancy
resolves within 6 weeks of delivery
No proteinuria/oedema

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7
Q

features of pre-eclampsia

A

Hypertension, proteinuria, oedema

Proteinuria = >0.3g/L

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8
Q

pathogenesis of pre-eclampsia

A

Failure of trophoblast invasion- reducing blood flow to the placenta
Due to decreased placental perfusion, mother raises blood pressure to compensate

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9
Q

How can pre-eclampsia affect the CNS

A

Hypertensive encephalopathy
intra-cranial haemorrhage
Cerebral oedema
cranial nerve palsy

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10
Q

how can pre-eclampsia affect the resp system

A

Pulmonary oedema– ARDS

PE

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11
Q

how can pre-eclampsia affect the renal system

A

Decreased GFR
Increase serum uric acid, creatinine, potassium, urea
Acute renal failure- acute tubular necrosis, renal cortical necrosis

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12
Q

How can pre-eclampsia affect the liver

A

RUQ pain
abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome

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13
Q

what is HELLP syndrome

A

severe pre-eclampsia characterised by Haemolysis, Elevated liver enzymes, Low platelets

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14
Q

how can pre-eclampsia affect the placenta

A

IUGR
Placentral abruption
Intra-uterine death

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15
Q

symptoms of pre-eclampsia

A 
Headache
Visual disturbance
RUQ pain 
Nausea + Vomiting 
Rapidly progressing oedema
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16
Q

Most significant risk factor for pre-eclampsia

A

previous pre-eclampsia

17
Q

Other risk factors for pre-eclampsia

A 
Maternal age >40 
Maternal BMI >30 
Family history 
First pregnancy 
Multiple pregnancy (e.g. twins)
18
Q

Medical risk factors for pre-eclampsia

A

Pre-existing renal disease/ hypertension
Diabetes
Connective tissue disease
Thrombophilias

19
Q

Investigations for pre-eclampsia

A 
U + E 
Serum urate
LFTs
FBCs
Coagulation screen
Urine PCR
CTG
USS
20
Q

what drug is used in high risk women to prevent pregnancy induced hypertension (PET)

A

75mg Aspirin

21
Q

when should a woman be admitted

A
  1. BP >170/110 OR >140/90 with proteinuria
  2. Significant symptoms
  3. Abnormal biochemistry
  4. Significant proteinuria >300mg/24 hrs
  5. Need for antihypertensive therapy
  6. Signs of fetal compromise
22
Q

What BP level requires treatment

A

> 150/100

23
Q

What hypertension drugs are NOT safe in pregnancy

A

ACEi/ ARBs

Diuretics

24
Q

1st line agent for hypertension

A

Labetolol 100mg bd

alpha + beta antagonist

25
Q

2nd line agent for hypertension

A

Methyldopa 250mg bd

alpha agonist

26
Q

3rd line agent for hypertension

A

Nifedipine 10mg bd

Ca channel antagonist

27
Q

which drug is contraindicated in depression

A

Methyldopa

28
Q

which drug is contraindicated in asthmatics

A

Labetolol

29
Q

what is eclampsia

A

Tonic-clonic seizure occurring with features of pre-eclampsia

30
Q

which age group is eclampsia most common in

A

teenagers

31
Q

Management of eclampsia

A

Antihypertensives- IV labetolol and/or hydralazine

Prevent seizures= IV magnesium sulphate

32
Q

what is the dose of magnesium sulphate in eclampsia

A

4g IV over 5 mins

33
Q

what is considered if seizures are persistent

A

diazepam 10mg IV

34
Q

cure of pre-eclampsia

A

delivery, most delivered within 2 weeks

Reproduction Year 3 (36 decks)

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