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3 Reproduction and Sexual Health > Hypertension in Pregnancy > Flashcards

Hypertension in Pregnancy Flashcards

1
Q

commonest cause of iatrogenic prematurity?

A

pre-eclampsia

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2
Q

there is vaso___ in pregnancy

A

dilatation

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3
Q

what happens to BP post-natally?

A

goes down then reaches a peak at day 3/4 PN then settles back down around day 10

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4
Q

what BP would indicate HT in pregnancy

A

> 140/90mmHg on 2 occasions

160/110mmHg once

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5
Q

when would you assume a mother has pre-existing hypertension?

A

PMH
if they have high/upper normal BP in 1T
(PET is a disease of 2T+)

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6
Q

Ix hypertension in pregnancy

A

ECHO
TFTs
renal USS
consider phaeo

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7
Q

what is PIH? when does it occur and resolve?

A

pregnancy induced hypertension
second half of pregnancy
within 6 weeks of delivery

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8
Q

how does PIH differ from PET?

A

don’t get proteinuria etc, only hypertension in PIH

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9
Q

3 main symptoms of PET? do you need them all?

A

hypertension
proteinuria (>0.3g/l)
oedema
no

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10
Q

pathophysiology of PET?

A
  1. failed trophoblast invasion causes spiral arteries to the placenta to have low resistance
  2. placental ischaemia = dec perfusion
  3. maternal effect from this is endothelial dysfunction
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11
Q

screening Ix antenatally for PET?

A

BP
urinalysis for protein
maternal uterine artery doppler USS

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12
Q

what gestation marks the division between early and late pre-eclampsia

A

34 weeks

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13
Q

majority of PET is early/late

A

late

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14
Q

placental vascular and villous lesions are more common in early or late PET?

A

early

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15
Q

effects of PET on CNS?

A 
intracranial haemorrhage
cerebral oedema
cortical blindness
CN palsy
hypertensive encephalopathy
eclampsia
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16
Q

symptoms of renal disease in PET?

A

proteinuria

oliguria

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17
Q

symptoms of liver disease in PET?

A

RUQ pain

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18
Q

symptoms of HELLP syndrome?

A

haemolysis
elevated liver enzymes
low platelets

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19
Q

Ix liver disease in PET?

A

LFTs

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20
Q

why do you get oedema in PET?

A

leaky BVs from endothelial dysfunction

21
Q

what happens to plasma volume in PET?

A

decreases

22
Q

resp complications of PET?

A

pulm oedema -> ARDS

PE

23
Q

complications of placental disease?

A

FGR

placental abruption

24
Q

symptoms of systemic PET?

A 
headache
visual disturbance
epigastric/RUQ pain
N+V
rapidly progressive oedema
confusion
25
Q

signs of PET?

A 
hypertension
proteinuria
oedema
abdo tenderness
disorientation
SGA baby
IUD
hyperreflexia, involuntary movements, clonus (CNS issue)
26
Q

Ix PET

A 
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
27
Q

Tx PET

A 
in hosp if PET, home if PIH
treat HT
surveillance
steroids before delivery
DELIVERY (weigh up risks and benefits)
28
Q

maternal risks for PET

A 
age
BMI
FH
para 1
multiple pregnancy
previous PET
large birth interval
29
Q

multiparous women have less severe PET

A

F, it is more severe and occurs earlier

30
Q

medical causes of PET

A

pre-existing renal or CT disease
thrombophilia
pre-existing HT
diabetes

31
Q

when would you give PET prophylaxis? what dose?

A

low dose aspirin 75mg pd to high risk women before 12 weeks gestation

32
Q

what should you look at in a MUAD scan?

A

uterine artery
iliac artery and vein
NB uterine artery crosses the vessels

33
Q

indication on uterine artery doppler that suggests PET?

A

“bilateral notching” on MUAD

34
Q

when would you admit someone with PET?

A 
BP >140/90 with proteinuria
BP >170/110
systemic symptoms
abnormal biochem
severe proteinuria
fetal compromise
need antihypertensives
35
Q

when are BP, CTG and urinalysis done for PET inpatients?

A

BP every 4hrs
CTG daily
urinalysis daily

36
Q

1st line antihypertensive in pregnancy?

A

100mg labetalol

37
Q

contraindication to labetalol? what should be given?

A

asthma

nifedipine

38
Q

contraindication to methyl dopa? what kind of drug is it?

A

depression

alpha agonist

39
Q

what BP drug in pregnancy is contraindicated in breast feeding?

A

doxazosin

40
Q

what hypertensive drug classes are contraindicated in pregnancy?

A

ACEi

diuretics

41
Q

BP aim for PET patients?

A

140/90mmHg

42
Q

an MAP >___mmHg indicates a significant risk of…..

A

150

cerebral haemorrhage

43
Q

what factors would make you sway more towards delivering the baby?

A 
near term
can't control BP
eclampsia
rapid deterioration
fetal compromise - REDF, abnormal CTG
44
Q

define eclampsia

A

tonic clonic seizure in someone with features of PET

45
Q

eclampsia is more common at what age?

A

teenagers

46
Q

patients with eclampsia will always have PET symptoms before the seizure T or Fq

A

F, >1/3 will have seizure first

47
Q

Tx of eclampsia

A 
fluid balance
control BP
IV labetalol, IV hydralazine
MgSO4 IV for seizures
delivery
48
Q

Tx of seizures in eclampsia

A
  1. 1g MgSO4 IV
  2. 2g MgSO4 IV
  3. diazepam 10mg IV
49
Q

Ix suspected renal dysfunction from fluid overload

A

urine osmolality

3 Reproduction and Sexual Health (51 decks)

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