Hypertension in Pregnancy Flashcards
Describe normal blood pressure in pregnancy.
decreased in early pregnancy - lowest 22-24 weeks
steady increase until term
What happens to blood pressure after delivery?
decreases again
increases and peaks 3-4 days post natal
What are the risks of pre existing hypertension in pregnancy?
pre eclampsia
IUGR
abruption
How is preexisting hypertension in pregnancy treated?
STOP ACEi, A2A blockers and chlorothiazide
treat with labetalol, nifedipine
aim for <150/90
What is PIH?
pregnancy induced hypertension
increased blood pressure in second half of pregnancy and resolves within 6 weeks of delivery
How is pregnancy induced hypertension treated?
labetalol, nifedipine, methyldopa
What is preeclampsia?
pregnancy induced hypertension with proteinuria +/- oedema
multisystem disorder
What is the pathogenesis of preeclampsia?
originates in placenta - failure of trophoblastic invasion of spiral arteries leaving them vasoactive
when properly invaded they can’t clamp down in response to vasoconstrictors - this protects placental flow - doesn’t happen in preeclampsia
What are the risk factors for pre eclampsia?
high risk
- chronic hypertension
- hypertension in previous pregnancy
- CKD
- DM
- AI disease
moderate risk
- first pregnancy
- > 40
- obesity
- FHx
- multiple pregnancy
How does preeclampsia present?
variable presentation - widespread manifestations ?asymptomatic N and V epigastric/RUQ pain visual disturbance headache rapidly progressive oedema
How is preeclampsia investigated?
FBC USS coag screen CTG serum urate LFTs
What is prophylaxis for preeclampsia?
1 high risk or 2 moderate risks - low dose aspirin from 12th week
How is hypertension treated in preeclampsia?
labetelol, nifedipine, methyldopa
What are indications for delivery in preeclampsia?
can’t control bp
fetal compromise
term gestation
eclampsia or other crises
What is HELLP syndrome?
haemolysis
elevated liver enzymes
low platelets
