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
falls after delivery
subsequently rises and peaks at day 3/4 post part
Values for a diagnosis of hypertension
> 140/90 mmHg on 2 occaisions
> 160/110 mmHg once
why does BP decrease in early pregnancy
reduced TPR (total peripheral resistance) due to vasodilation
risks of pre-existing hypertension in pregnancy
Pre-eclampsia
IUGR
Placental abruption
features of pregnancy induced hypertension
disease of the second half of pregnancy
resolves within 6 weeks of delivery
No proteinuria/oedema
features of pre-eclampsia
Hypertension, proteinuria, oedema
Proteinuria = >0.3g/L
pathogenesis of pre-eclampsia
Failure of trophoblast invasion- reducing blood flow to the placenta
Due to decreased placental perfusion, mother raises blood pressure to compensate
How can pre-eclampsia affect the CNS
Hypertensive encephalopathy
intra-cranial haemorrhage
Cerebral oedema
cranial nerve palsy
how can pre-eclampsia affect the resp system
Pulmonary oedema– ARDS
PE
how can pre-eclampsia affect the renal system
Decreased GFR
Increase serum uric acid, creatinine, potassium, urea
Acute renal failure- acute tubular necrosis, renal cortical necrosis
How can pre-eclampsia affect the liver
RUQ pain
abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome
what is HELLP syndrome
severe pre-eclampsia characterised by Haemolysis, Elevated liver enzymes, Low platelets
how can pre-eclampsia affect the placenta
IUGR
Placentral abruption
Intra-uterine death
symptoms of pre-eclampsia
Headache Visual disturbance RUQ pain Nausea + Vomiting Rapidly progressing oedema
Most significant risk factor for pre-eclampsia
previous pre-eclampsia
Other risk factors for pre-eclampsia
Maternal age >40 Maternal BMI >30 Family history First pregnancy Multiple pregnancy (e.g. twins)
Medical risk factors for pre-eclampsia
Pre-existing renal disease/ hypertension
Diabetes
Connective tissue disease
Thrombophilias
Investigations for pre-eclampsia
U + E Serum urate LFTs FBCs Coagulation screen Urine PCR CTG USS
what drug is used in high risk women to prevent pregnancy induced hypertension (PET)
75mg Aspirin
when should a woman be admitted
- BP >170/110 OR >140/90 with proteinuria
- Significant symptoms
- Abnormal biochemistry
- Significant proteinuria >300mg/24 hrs
- Need for antihypertensive therapy
- Signs of fetal compromise
What BP level requires treatment
> 150/100
What hypertension drugs are NOT safe in pregnancy
ACEi/ ARBs
Diuretics
1st line agent for hypertension
Labetolol 100mg bd
alpha + beta antagonist
2nd line agent for hypertension
Methyldopa 250mg bd
alpha agonist
3rd line agent for hypertension
Nifedipine 10mg bd
Ca channel antagonist
which drug is contraindicated in depression
Methyldopa
which drug is contraindicated in asthmatics
Labetolol
what is eclampsia
Tonic-clonic seizure occurring with features of pre-eclampsia
which age group is eclampsia most common in
teenagers
Management of eclampsia
Antihypertensives- IV labetolol and/or hydralazine
Prevent seizures= IV magnesium sulphate
what is the dose of magnesium sulphate in eclampsia
4g IV over 5 mins
what is considered if seizures are persistent
diazepam 10mg IV
cure of pre-eclampsia
delivery, most delivered within 2 weeks
