Hypertension in Pregnancy Flashcards
commonest cause of iatrogenic prematurity?
pre-eclampsia
there is vaso___ in pregnancy
dilatation
what happens to BP post-natally?
goes down then reaches a peak at day 3/4 PN then settles back down around day 10
what BP would indicate HT in pregnancy
> 140/90mmHg on 2 occasions
160/110mmHg once
when would you assume a mother has pre-existing hypertension?
PMH
if they have high/upper normal BP in 1T
(PET is a disease of 2T+)
Ix hypertension in pregnancy
ECHO
TFTs
renal USS
consider phaeo
what is PIH? when does it occur and resolve?
pregnancy induced hypertension
second half of pregnancy
within 6 weeks of delivery
how does PIH differ from PET?
don’t get proteinuria etc, only hypertension in PIH
3 main symptoms of PET? do you need them all?
hypertension
proteinuria (>0.3g/l)
oedema
no
pathophysiology of PET?
- failed trophoblast invasion causes spiral arteries to the placenta to have low resistance
- placental ischaemia = dec perfusion
- maternal effect from this is endothelial dysfunction
screening Ix antenatally for PET?
BP
urinalysis for protein
maternal uterine artery doppler USS
what gestation marks the division between early and late pre-eclampsia
34 weeks
majority of PET is early/late
late
placental vascular and villous lesions are more common in early or late PET?
early
effects of PET on CNS?
intracranial haemorrhage cerebral oedema cortical blindness CN palsy hypertensive encephalopathy eclampsia
symptoms of renal disease in PET?
proteinuria
oliguria
symptoms of liver disease in PET?
RUQ pain
symptoms of HELLP syndrome?
haemolysis
elevated liver enzymes
low platelets
Ix liver disease in PET?
LFTs
why do you get oedema in PET?
leaky BVs from endothelial dysfunction
what happens to plasma volume in PET?
decreases
resp complications of PET?
pulm oedema -> ARDS
PE
complications of placental disease?
FGR
placental abruption
symptoms of systemic PET?
headache visual disturbance epigastric/RUQ pain N+V rapidly progressive oedema confusion
signs of PET?
hypertension proteinuria oedema abdo tenderness disorientation SGA baby IUD hyperreflexia, involuntary movements, clonus (CNS issue)
Ix PET
U+Es serum urate LFTs FBC coag screen - late sign urinalysis, if +ve urine PCR CTG - manages baby's HR, o2 sats USS - doppler, amniotic fluid index
Tx PET
in hosp if PET, home if PIH treat HT surveillance steroids before delivery DELIVERY (weigh up risks and benefits)
maternal risks for PET
age BMI FH para 1 multiple pregnancy previous PET large birth interval
multiparous women have less severe PET
F, it is more severe and occurs earlier
medical causes of PET
pre-existing renal or CT disease
thrombophilia
pre-existing HT
diabetes
when would you give PET prophylaxis? what dose?
low dose aspirin 75mg pd to high risk women before 12 weeks gestation
what should you look at in a MUAD scan?
uterine artery
iliac artery and vein
NB uterine artery crosses the vessels
indication on uterine artery doppler that suggests PET?
“bilateral notching” on MUAD
when would you admit someone with PET?
BP >140/90 with proteinuria BP >170/110 systemic symptoms abnormal biochem severe proteinuria fetal compromise need antihypertensives
when are BP, CTG and urinalysis done for PET inpatients?
BP every 4hrs
CTG daily
urinalysis daily
1st line antihypertensive in pregnancy?
100mg labetalol
contraindication to labetalol? what should be given?
asthma
nifedipine
contraindication to methyl dopa? what kind of drug is it?
depression
alpha agonist
what BP drug in pregnancy is contraindicated in breast feeding?
doxazosin
what hypertensive drug classes are contraindicated in pregnancy?
ACEi
diuretics
BP aim for PET patients?
140/90mmHg
an MAP >___mmHg indicates a significant risk of…..
150
cerebral haemorrhage
what factors would make you sway more towards delivering the baby?
near term can't control BP eclampsia rapid deterioration fetal compromise - REDF, abnormal CTG
define eclampsia
tonic clonic seizure in someone with features of PET
eclampsia is more common at what age?
teenagers
patients with eclampsia will always have PET symptoms before the seizure T or Fq
F, >1/3 will have seizure first
Tx of eclampsia
fluid balance control BP IV labetalol, IV hydralazine MgSO4 IV for seizures delivery
Tx of seizures in eclampsia
- 1g MgSO4 IV
- 2g MgSO4 IV
- diazepam 10mg IV
Ix suspected renal dysfunction from fluid overload
urine osmolality
