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Reproductive - Pregnancy > Hypertension in Pregnancy > Flashcards

Hypertension in Pregnancy Flashcards

1
Q

Mild pre-eclampsia is seen in what % of primigravid women? Severe pre-eclampsia is seen in what % of primigravid women?

A

10% / 1%

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2
Q

What is the defining feature of eclampsia?

A

A seizure

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3
Q

Hypertension which develops in pregnancy but has no associated proteinuria is known as what?

A

Pregnancy induced / gestational hypertension

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4
Q

Hypertension which develops in pregnancy and has associated proteinuria is known as what?

A

Pre-eclampsia

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5
Q

Pregnancy causes vasodilation, so describe what usually happens to blood pressure in pregnancy until 24 weeks?

A

BP falls in early pregnancy, and reaches its lowest point at 22-24 weeks

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6
Q

Pregnancy causes vasodilation, so describe what usually happens to blood pressure in pregnancy after 24 weeks?

A

It will steadily rise until term

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7
Q

Pregnancy causes vasodilation, so describe what usually happens to blood pressure after delivery?

A

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.

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8
Q

How is hypertension in pregnancy diagnosed?

A

140+ systolic / 90+ diastolic on two occasions or >160/>110 diastolic on one occasion

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9
Q

What are some risks of severe hypertension in pregnancy?

A

Placental abruption, foetal growth restriction, CVA

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10
Q

What is pre-existing hypertension?

A

When the woman has been diagnosed with hypertension before becoming pregnant

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11
Q

If a woman has hypertension in early pregnancy (i.e. < 20 weeks), what is the most likely cause?

A

Pre-existing hypertension

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12
Q

A retrospective diagnosis of pre-existing hypertension can be made if a woman’s BP has not returned to normal how long after delivery?

A

3 months

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13
Q

What are some potential secondary causes of pre-existing hypertension?

A

Cardiac or renal disease, Cushing’s or Conn’s syndromes, phaeochromocytoma

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14
Q

What happens to the risk of developing PET if you have pre-existing hypertension?

A

The risk is doubled

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15
Q

When does pregnancy induced hypertension occur? When should it resolve by?

A

In the second half of pregnancy, generally > 20 weeks / within 6 weeks of delivery

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16
Q

What % of cases of pregnancy induced hypertension go on to become pre-eclampsia?

A

15%

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17
Q

What is the rate of recurrence of pregnancy induced hypertension?

A

High rate of recurrence

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18
Q

What are the 3 major features of pre-eclampsia? Do these all need to be present for a diagnosis to be made?

A

Hypertension, proteinuria and oedema - no, absence of one of these does not exclude the diagnosis

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19
Q

What is the definition of proteinuria?

A

0.3g/l+ or 0.3g/24 hours+

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20
Q

What is pre-eclampsia?

A

A pregnancy specific multi-system disorder with variable, unpredictable and widespread manifestations

21
Q

Are women with pre-eclampsia always symptomatic?

A

No, they can be asymptomatic at the time of diagnosis

22
Q

What defines early and late pre-eclampsia? Which is more common?

A

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

23
Q

Describe what happens to the placenta in a) early pre-eclampsia? b) late pre-eclampsia?

A

a) associated with extensive villous and vascular lesions of the placenta b) minimal placental lesions

24
Q

Which type of pre-eclampsia has a higher risk of maternal and foetal complications?

A

Early

25
Q

What are some factors which may have a role in the development of late pre-eclampsia?

A

Maternal factors e.g. pre-existing hypertension/metabolic syndrome

26
Q

Describe the brief pathogenesis of pre-eclampsia?

A

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.

27
Q

What effect does the endothelial dysfunction in pre-eclampsia have?

A

Leads to local vasospasm which causes hypoperfusion of organs

28
Q

What are some maternal risk factors for the development of pre-eclampsia?

A

Increased maternal age and BMI, family history

29
Q

What is the risk of developing pre-eclampsia if a woman’s a) mother or b) sister is affected?

A

a) 20-25% b) 40%

30
Q

What are some pregnancy related risk factors for the development of pre-eclampsia?

A

First pregnancy, multiple pregnancy, large pregnancy interval, molar pregnancy

31
Q

What are some medical risk factors for the development of pre-eclampsia?

A

Pre-existing renal disease or hypertension, diabetes (pre-existing or gestational), connective tissue disease, thrombophilias, previous VTE

32
Q

What type of seizure generally occurs as a result of eclampsia? When are these most-least likely to occur?

A

Generalised tonic-clonic seizure / postpartum, antepartum, intrapartum

33
Q

Do features of pre-eclampsia have to be present to have an eclamptic seizure?

A

No, 1/3rd of seizures will present before the onset of hypertension/proteinuria

34
Q

Apart from seizures, what may be some other CNS features of pre-eclampsia?

A

Hypertensive encephalopathy, intracranial haemorrhage, cortical blindness, cranial nerve palsies

35
Q

Pre-eclampsia leads to a decreased GFR - what does this cause? What can this progress to?

A

Proteinuria and oliguria / acute renal failure

36
Q

What can happen to the liver in pre-eclampsia? What symptom can this cause?

A

Abnormal liver enzymes and stretching/rupture of the liver capsule which can lead to RUQ/epigastric pain

37
Q

What are the features of HELLP syndrome?

A

Haemolysis, elevated liver enzymes, low platelets

38
Q

What are some respiratory problems which can occur in pre-eclampsia?

A

Pulmonary oedema which can lead to ARDS / PE

39
Q

What are some problems that placental disease in pre-eclampsia can cause?

A

Foetal growth restriction, placental abruption, intrauterine death

40
Q

What are the main symptoms of pre-eclampsia?

A

Headache, visual disturbance, RUQ pain, N+V, rapidly progressing oedema

41
Q

What are some examples of the visual disturbance that can occur in pre-eclampsia? What causes this?

A

Blurred vision, flashing lights, scotoma / retinal hypoperfusion

42
Q

Apart from the main 3, what are some other potential signs of pre-eclampsia?

A

Abdominal tenderness, disorientation, SGA baby, hyper-reflexia/involuntary movements/clonus

43
Q

What blood tests should be done in suspected pre-eclampsia?

A

Us and Es, LFTs, FBCs, coagulation screen

44
Q

What investigations relating to renal function should be done in suspected pre-eclampsia?

A

Serum urate and urine PCR

45
Q

What investigations relating to the baby should be done n suspected pre-eclampsia?

A

Cardiotocography, ultrasound for foetal biometry, amniotic fluid index and Doppler

46
Q

What investigation can be used to predict the risk of pre-eclampsia and when should it be done?

A

Uterine artery Doppler at 20-24 weeks

47
Q

What seen on uterine artery Doppler would indicate a high risk of pre-eclampsia? What should be done from there?

A

Bilateral notching in diastole / bring back for growth scans every 4 weeks

48
Q

What is the single biggest risk factor for the development of pre-eclampsia?

A

Having had it previously

Reproductive - Pregnancy (11 decks)

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