Hypertension in Pregnancy Flashcards
Mild pre-eclampsia is seen in what % of primigravid women? Severe pre-eclampsia is seen in what % of primigravid women?
10% / 1%
What is the defining feature of eclampsia?
A seizure
Hypertension which develops in pregnancy but has no associated proteinuria is known as what?
Pregnancy induced / gestational hypertension
Hypertension which develops in pregnancy and has associated proteinuria is known as what?
Pre-eclampsia
Pregnancy causes vasodilation, so describe what usually happens to blood pressure in pregnancy until 24 weeks?
BP falls in early pregnancy, and reaches its lowest point at 22-24 weeks
Pregnancy causes vasodilation, so describe what usually happens to blood pressure in pregnancy after 24 weeks?
It will steadily rise until term
Pregnancy causes vasodilation, so describe what usually happens to blood pressure after delivery?
It will initially fall, but subsequently rises and peaks at 3-4 days postnatally. By 10 days after delivery the BP should be back to pre-pregnancy levels.
How is hypertension in pregnancy diagnosed?
140+ systolic / 90+ diastolic on two occasions or >160/>110 diastolic on one occasion
What are some risks of severe hypertension in pregnancy?
Placental abruption, foetal growth restriction, CVA
What is pre-existing hypertension?
When the woman has been diagnosed with hypertension before becoming pregnant
If a woman has hypertension in early pregnancy (i.e. < 20 weeks), what is the most likely cause?
Pre-existing hypertension
A retrospective diagnosis of pre-existing hypertension can be made if a woman’s BP has not returned to normal how long after delivery?
3 months
What are some potential secondary causes of pre-existing hypertension?
Cardiac or renal disease, Cushing’s or Conn’s syndromes, phaeochromocytoma
What happens to the risk of developing PET if you have pre-existing hypertension?
The risk is doubled
When does pregnancy induced hypertension occur? When should it resolve by?
In the second half of pregnancy, generally > 20 weeks / within 6 weeks of delivery
What % of cases of pregnancy induced hypertension go on to become pre-eclampsia?
15%
What is the rate of recurrence of pregnancy induced hypertension?
High rate of recurrence
What are the 3 major features of pre-eclampsia? Do these all need to be present for a diagnosis to be made?
Hypertension, proteinuria and oedema - no, absence of one of these does not exclude the diagnosis
What is the definition of proteinuria?
0.3g/l+ or 0.3g/24 hours+
What is pre-eclampsia?
A pregnancy specific multi-system disorder with variable, unpredictable and widespread manifestations
Are women with pre-eclampsia always symptomatic?
No, they can be asymptomatic at the time of diagnosis
What defines early and late pre-eclampsia? Which is more common?
Early is defined as diagnosis or delivery at < 34 weeks, any later than this is late / Late pre-eclampsia makes up the majority of cases
Describe what happens to the placenta in a) early pre-eclampsia? b) late pre-eclampsia?
a) associated with extensive villous and vascular lesions of the placenta b) minimal placental lesions
Which type of pre-eclampsia has a higher risk of maternal and foetal complications?
Early
What are some factors which may have a role in the development of late pre-eclampsia?
Maternal factors e.g. pre-existing hypertension/metabolic syndrome
Describe the brief pathogenesis of pre-eclampsia?
There is genetic and environmental factors which predispose to defective placentation causing utero-placental arteries to become fibrous and narrow. The underperfused placenta then releases pro-inflammatory proteins into the maternal circulation which lead to endothelial dysfunction.
What effect does the endothelial dysfunction in pre-eclampsia have?
Leads to local vasospasm which causes hypoperfusion of organs
What are some maternal risk factors for the development of pre-eclampsia?
Increased maternal age and BMI, family history
What is the risk of developing pre-eclampsia if a woman’s a) mother or b) sister is affected?
a) 20-25% b) 40%
What are some pregnancy related risk factors for the development of pre-eclampsia?
First pregnancy, multiple pregnancy, large pregnancy interval, molar pregnancy
What are some medical risk factors for the development of pre-eclampsia?
Pre-existing renal disease or hypertension, diabetes (pre-existing or gestational), connective tissue disease, thrombophilias, previous VTE
What type of seizure generally occurs as a result of eclampsia? When are these most-least likely to occur?
Generalised tonic-clonic seizure / postpartum, antepartum, intrapartum
Do features of pre-eclampsia have to be present to have an eclamptic seizure?
No, 1/3rd of seizures will present before the onset of hypertension/proteinuria
Apart from seizures, what may be some other CNS features of pre-eclampsia?
Hypertensive encephalopathy, intracranial haemorrhage, cortical blindness, cranial nerve palsies
Pre-eclampsia leads to a decreased GFR - what does this cause? What can this progress to?
Proteinuria and oliguria / acute renal failure
What can happen to the liver in pre-eclampsia? What symptom can this cause?
Abnormal liver enzymes and stretching/rupture of the liver capsule which can lead to RUQ/epigastric pain
What are the features of HELLP syndrome?
Haemolysis, elevated liver enzymes, low platelets
What are some respiratory problems which can occur in pre-eclampsia?
Pulmonary oedema which can lead to ARDS / PE
What are some problems that placental disease in pre-eclampsia can cause?
Foetal growth restriction, placental abruption, intrauterine death
What are the main symptoms of pre-eclampsia?
Headache, visual disturbance, RUQ pain, N+V, rapidly progressing oedema
What are some examples of the visual disturbance that can occur in pre-eclampsia? What causes this?
Blurred vision, flashing lights, scotoma / retinal hypoperfusion
Apart from the main 3, what are some other potential signs of pre-eclampsia?
Abdominal tenderness, disorientation, SGA baby, hyper-reflexia/involuntary movements/clonus
What blood tests should be done in suspected pre-eclampsia?
Us and Es, LFTs, FBCs, coagulation screen
What investigations relating to renal function should be done in suspected pre-eclampsia?
Serum urate and urine PCR
What investigations relating to the baby should be done n suspected pre-eclampsia?
Cardiotocography, ultrasound for foetal biometry, amniotic fluid index and Doppler
What investigation can be used to predict the risk of pre-eclampsia and when should it be done?
Uterine artery Doppler at 20-24 weeks
What seen on uterine artery Doppler would indicate a high risk of pre-eclampsia? What should be done from there?
Bilateral notching in diastole / bring back for growth scans every 4 weeks
What is the single biggest risk factor for the development of pre-eclampsia?
Having had it previously
