Hypertension in pregnancy Flashcards
Hypertension in pregnancy has risks for both mother and child - give some maternal risks
- CVA
- Renal failure
- Heart failure
- Coagulation failure
- Liver failure
- Adrenal failure
- (Pre)/eclampsia
Hypertension in pregnancy has risks for both mother and child - give some foetal risks
- Asymmetrical IUGR
- Placental abruption
- Iatrogenic preterm delivery
Define pregnancy induced hypertension
New onset hypertension, greater than 140/80, after 20weeks gestation
What is hypertension present at booking/prior to 20 weeks or already controlled with an antihypertensive termed?
Chronic hypertension
How is pregnancy induced hypertension (PIH) classified?
Mild; 140-149 systolic or 90-99 diastolic
Moderate; 150-159 systolic or 100-109 diastolic
Severe; >160 systolic or >110 diastolic
True/false - isolated hypertension without proteinuria is unlikely to be a risk to mum
True
Define significant proteinuria
Greater than 300mg in 24hrs.
What are the risks for PIH and pre-eclampsia?
- Primigravidae
- had them severe in first pregnancy
- Changed partners between pregnancies
- pregnancy complicated by Hydatidiform mole
- GDM
- Antiphospholipid syndrome
- Multiple pregnancy
Give a BRIEF summary of the cause of pre-eclampsia
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
How does PIH typically present in a primigravida?
Late in third semester. Usually mild. Needs no intervention
For moderate PI hypertension, you should treat - how?
Oral labetalol - no need to admit. Aim for BP less than 150/100 and diastolic greater than 80
For severe PI hypertension, you should treat - how?
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
What else can you give if the patient can’t take labetalol or you need a second agent?
Nifedipine (calcium channel blocker licensed in pregnancy)
ACEIs are safe in pregnancy - true/false
false - Risk of foetal renal damage
Symptoms of pre-eclampsia include…
- Headache
- upper abdo pain
- reduced foetal movements
- oedema
(uncommonly may get visual changes, breathlessness and oliguria)
Risks for pre-eclampsia include…
- obesity
- > 35y/o
- multiple pregnancy
- pre-existing DM
- FHx
- renal disease
- chronic hypertension
Signs of pre-eclampsia include…
- hypertension
- proteinuria
- oedema
(also less commonly - hyper-reflexia and clonus)
What is the significant of b/lateral uterine artery notching?
Much higher risk of pre-eclampsia
What are the options for definitive treatment of PIH and pre-eclampsia?
No options except delivery - usually reverses immediately after delivery of placenta
What is the mainstay of treatment for PIH and pre-eclampsia?
Prevent progression and deterioration using antihypertensives (labetalol/nifedipine/methydopa_ and anti-convulsants (magnesium sulphate) to prevent full eclampsia
When should delivery be performed for PIH/pre-eclampsia?
Ideally at/just after 36 weeks
If delivering before 32 weeks how should baby be delivered?
LUSCS
If delivering between 32 and 36 weeks how should baby be delivered?
Debated - can be either LUSCS or vaginal delivery with induction of labour
If delivering before 34 weeks what else do you need to give baby?
Steroids
If delivering at 36 weeks, how should baby be delivered?
By vaginal delivery unless otherwise contraindicated
Eclampsia is uncommon in the UK - but what is it?
Seizures
with moderate to severe hypertension
What causes the seizure?
Cerebral oedema and cerebral vasoconstriction
Results in hypoxia and a typical epileptiform fit
What type of seizure is present in eclampsia?
Epileptiform - with twitching, tonic phase, clonic phase and post-icthal stage.
How do you manage eclampsia?
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.
