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Y3 OBS AND GYNAE > Hypertension in Pregnancy > Flashcards

Hypertension in Pregnancy Flashcards

1
Q

What happens to vessels during pregnancy?

A

Vasodilation

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2
Q

Is blood pressure high or low in early pregnancy?

A

Low

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3
Q

Is blood pressure high or low in late pregnancy?

A

High

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4
Q

When is the lowest blood pressure in pregnancy?

A

22-24 weeks

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5
Q

What are the parameters/criteria for diagnosing hypertension in pregnancy?

A

Greater than 140/90 on 2 occasions

Greater than 160/110 once

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6
Q

What is the most common cause of prematurity during pregnancy?

A

Preclampsia

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7
Q

If hypertension persists within 3 months of delivery of a baby, what is the likely diagnosis?

A

Pre-existing (undiagnosed) hypertension

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8
Q

If hypertension occurs in early pregnancy, what is the differential diagnosis?

A

Pre-existing hypertension

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9
Q

List some secondary causes of pre-existing hypertension

A 
Renal
Cardiac
Cushings
Conns
Phaechromocytoma
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10
Q

If hypertension occurs in second half of pregnancy, what are the differential diagnoses?

A

Pregnancy-induced hypertension

Preclampsia

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11
Q

When should pregnancy-induced hypertension resolve by?

A

6 weeks following delivery

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12
Q

There is a high recurrence rate of pregnancy-induced hypertension. True/ False?

A

True

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13
Q

What is the triad of features present in pre-eclampsia?

A

Hypertension
Proteinuria
Oedema

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14
Q

Absence of symptoms excludes diagnosis of pre-eclampsia. True/ False?

A

False

Often asymptomatic at 1st presentation

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15
Q

How much proteinuria meets the criteria for pre-eclampsia?

A

0.3 g/l or more
0.3 g or more in 24 hour period
2+ on dipstick

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16
Q

How is pre-eclampsia classified?

A

Early (<34 weeks)

Late (>34 weeks)

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17
Q

Describe the pathogenesis of pre-eclampsia

A

Abnormal placental perfusion and failure of trophoblast invasion cause spiral arteries to stay as high resistance/low flow vessels, leading to placental endothelial damage and thrombosis

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18
Q

Preclampsia is a multi-system disorder. List the most common crisis’s found in preclampsia

A 
Eclampsia
HELLP syndrome
Pulmonary Oedema
Placental Abruption
Cerebral Haemorrhage
Cortical Blindness
Disseminated Intravascular Coagulation
Acute Renal Failure
Hepatic Rupture
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19
Q

What is the most common clinical sign of liver pathology in preclampsia?

A

Epigastric/ RUQ pain

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20
Q

Pulmonary oedema, as a complication of preclampsia, can result in which emergency condition?

A

ARDS

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21
Q

What syndrome related to liver disease are women with pre-eclampsia at risk of?

A

HELLP syndrome

22
Q

What are the clinical features of HELLP syndrome?

A

Haemolysis
Elevated Liver enzymes
Low platelet count

23
Q

What effect - vasodilation or vasoconstriction - does hypertension have on the placenta?

A

Vasoconstriction

24
Q

List symptoms of pre-eclampsia

A 
Headache
Visual disturbance
Epigastric/RUQ pain
Nausea/vomiting
Rapidly progressiv oedema
25
Q

List clinical signs of pre-eclampsia

A 
Hypertension/ Proteinuria/ Oedema
Abdominal tenderness
Disorientation
SGA
IUD
Hypereflexia
26
Q

List investigations used in the diagnosis of preclampsia

A 
U+Es/ Serum urate/ LFTs
FBC
Coag screen
Urine PCR
CTG
Ultrasound biometry, doppler
27
Q

List risk factors for preclampsia

A 
Maternal age >40 yrs
Maternal BMI >30
FHx
Parity (1st pregnancy)
Multiple pregnancy
Previous PE
Birth interval > 10 yrs
Molar pregnancy
Pre-existing hypertension
Thrombophilia
Pre-existing renal disease, DM, CTD
28
Q

What is the indication for aspirin in the management of preclampsia?

A

Prophylactic dose of 75mg aspirin for high risk women - renal disease, DM, APS, multiple pregnancy, Hx PET

29
Q

What is the mode of action of aspirin in the management of preclampsia?

A

Inhibits cyclo-oxygenase

Prevents TXA2 synthesis

30
Q

How can pre-eclampsia be screened for/predicted?

A

Maternal uterine artery doppler to assess blood flow at 20-24 weeks - if poor flow (notching) then high risk

31
Q

What blood pressure is aimed for in the treatment of hypertension during pregnancy?

A

140-150/90-100 mmHg

32
Q

What medication is used for hypertension in pregnancy 1st line? State the drug class for each

A
  1. Labetolol - alpha and beta blocker
  2. Nifedipine - Ca channel blocker
  3. Methyldopa - alpha agonist
33
Q

Labetolol is contraindicated in…

34
Q

Methyldopa is contraindicated in…

A

Depression

35
Q

What medication is used for hypertension in pregnancy 2nd line? State the drug class for each

A

Hydralazine - vasodilator

Doxazocin - alpha antagonist

36
Q

Which hypertensive drug class should be stopped in pregnancy?

37
Q

List methods used in surveillance of the fetus in preclampsia

A

Fetal movements
CTG daily
Ultrasound

38
Q

What is the only cure for pre-eclampsia?

A

Delivery of baby

Most women deliver within 2 weeks of diagnosis

39
Q

When should a baby aim to be delivered if there is pre-eclampsia?

40
Q

What medication is administered during labour to manage preclampsia?

A

Steroids

Dexamethasone

41
Q

What is eclampsia?

A

Tonic-clonic (grand mal) seizure occurring with pre-eclampsia features

42
Q

Is eclampsia more common antepartum, intrapartum or postpartum?

A

Postpartum

43
Q

What medications are used to control hypertension in severe preclampsia or eclampsia?

A

IV labetolol

IV hydralazine

44
Q

What should be given to treat seizures in eclampsia? If there is persistance of seizure, what other medication should be considered?

A

Magnesium sulphate IV

Diazepam IV

45
Q

When managing fluid balance in eclampsia, it’s safer to let patients run dry. True/ False?

A

True

Main cause of maternal death is pulmonary oedema from fluid overload

46
Q

What is the regime for IV fluids in eclampsia?

47
Q

Eclampsia should always be managed with c-section. True/False?

A

False

Aim for vaginal birth

48
Q

Why is epidural anaesthesia useful in delivery in eclampsia?

A

It’s a vasodilator - helps to reduce blood pressure

49
Q

List aspects of post-partum management for eclampsia

A 
Breastfeeding
Contraception
BP management
Counselling on future risk
Long term CVD risk
50
Q

Eclampsia is more common in which group of women?

Y3 OBS AND GYNAE (44 decks)

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