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4MB Obs and Gynae > Hypertension in pregnancy > Flashcards

Hypertension in pregnancy Flashcards

1
Q

Hypertension in pregnancy has risks for both mother and child - give some maternal risks

A
  • CVA
  • Renal failure
  • Heart failure
  • Coagulation failure
  • Liver failure
  • Adrenal failure
  • (Pre)/eclampsia
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2
Q

Hypertension in pregnancy has risks for both mother and child - give some foetal risks

A
  • Asymmetrical IUGR
  • Placental abruption
  • Iatrogenic preterm delivery
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3
Q

Define pregnancy induced hypertension

A

New onset hypertension, greater than 140/80, after 20weeks gestation

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4
Q

What is hypertension present at booking/prior to 20 weeks or already controlled with an antihypertensive termed?

A

Chronic hypertension

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5
Q

How is pregnancy induced hypertension (PIH) classified?

A

Mild; 140-149 systolic or 90-99 diastolic
Moderate; 150-159 systolic or 100-109 diastolic
Severe; >160 systolic or >110 diastolic

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6
Q

True/false - isolated hypertension without proteinuria is unlikely to be a risk to mum

A

True

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7
Q

Define significant proteinuria

A

Greater than 300mg in 24hrs.

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8
Q

What are the risks for PIH and pre-eclampsia?

A
  • Primigravidae
  • had them severe in first pregnancy
  • Changed partners between pregnancies
  • pregnancy complicated by Hydatidiform mole
  • GDM
  • Antiphospholipid syndrome
  • Multiple pregnancy
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9
Q

Give a BRIEF summary of the cause of pre-eclampsia

A

1) Failure of second wave trophoblast invasion
2) Altered prostacyclin/thromboxane ratio
3) Failure to reduce peripheral resistance
4) BP high throughout
5) Decreased perfusion of intervillous space and so asymmetrical growth restriction

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10
Q

How does PIH typically present in a primigravida?

A

Late in third semester. Usually mild. Needs no intervention

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11
Q

For moderate PI hypertension, you should treat - how?

A

Oral labetalol - no need to admit. Aim for BP less than 150/100 and diastolic greater than 80

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12
Q

For severe PI hypertension, you should treat - how?

A

Admit and treat with labetalol first line until BP >159/109. Monitor BP QDS in hospital. Monitor U+Es, FBC, transaminases and bili on admission and at least 1xweekly

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13
Q

What else can you give if the patient can’t take labetalol or you need a second agent?

A

Nifedipine (calcium channel blocker licensed in pregnancy)

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14
Q

ACEIs are safe in pregnancy - true/false

A

false - Risk of foetal renal damage

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15
Q

Symptoms of pre-eclampsia include…

A
  • Headache
  • upper abdo pain
  • reduced foetal movements
  • oedema
    (uncommonly may get visual changes, breathlessness and oliguria)
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16
Q

Risks for pre-eclampsia include…

A
  • obesity
  • > 35y/o
  • multiple pregnancy
  • pre-existing DM
  • FHx
  • renal disease
  • chronic hypertension
17
Q

Signs of pre-eclampsia include…

A
  • hypertension
  • proteinuria
  • oedema
    (also less commonly - hyper-reflexia and clonus)
18
Q

What is the significant of b/lateral uterine artery notching?

A

Much higher risk of pre-eclampsia

19
Q

What are the options for definitive treatment of PIH and pre-eclampsia?

A

No options except delivery - usually reverses immediately after delivery of placenta

20
Q

What is the mainstay of treatment for PIH and pre-eclampsia?

A

Prevent progression and deterioration using antihypertensives (labetalol/nifedipine/methydopa_ and anti-convulsants (magnesium sulphate) to prevent full eclampsia

21
Q

When should delivery be performed for PIH/pre-eclampsia?

A

Ideally at/just after 36 weeks

22
Q

If delivering before 32 weeks how should baby be delivered?

A

LUSCS

23
Q

If delivering between 32 and 36 weeks how should baby be delivered?

A

Debated - can be either LUSCS or vaginal delivery with induction of labour

24
Q

If delivering before 34 weeks what else do you need to give baby?

A

Steroids

25
Q

If delivering at 36 weeks, how should baby be delivered?

A

By vaginal delivery unless otherwise contraindicated

26
Q

Eclampsia is uncommon in the UK - but what is it?

A

Seizures

with moderate to severe hypertension

27
Q

What causes the seizure?

A

Cerebral oedema and cerebral vasoconstriction

Results in hypoxia and a typical epileptiform fit

28
Q

What type of seizure is present in eclampsia?

A

Epileptiform - with twitching, tonic phase, clonic phase and post-icthal stage.

29
Q

How do you manage eclampsia?

A

Magnesium sulphate to reduce frequency and severity of seizures
ABCDE - turn on side and maintain airway. Consider IV lorazepam Urgent and immediate delivery of the baby.

4MB Obs and Gynae (2 decks)

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