Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction > Hypertension in Pregnancy > Flashcards

Hypertension in Pregnancy Flashcards

1
Q

what is the commonest cause of iatrogenic prematurity

A

pre eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

proteinuria + oedema + hypertension = ?

A

pre eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the only definitive Tx for PET?

A

birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what CVS changes occur in pregnancy

A

plasma volume increases by 45%
CO increases by 30-50%
stoke volume increased by 25%
HR increases ny 15-25%

to compensate for this peripheral vascular resistance decreases by 15-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what changes happen to BP in pregnancy

A

minimal dip mid pregnancy then increases (not by as much as previously thought)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is diagnostic of hypertension in pregnancy

A

> /= 140/90 on 2 occasions or >160/110 once

or >30/15 compared to first trimester NP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the three forms of HPTx in pregnancy

A

Pre-existing hypertension

Pregnancy Induced Hypertension (PIH)

Pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

when might pre existing hypertension be diagnosed

A

prior to pregnancy
in early pregnancy (PET and PIH tend to occur in later pregnancy)
may be retrospective diagnosis (PET and PIH resolve after birth) if BP abnormal after 3 months of delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the risk of pre existing HPTx in pregnancy

A

PET
IUGR
abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what secondary causes should you consider in pre existing HPTx

A

renal/ cardiac
cushings
conns
phaeochromocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the features of pregnancy induced hypertension

A

happens in 2nd half of pregnancy
resolves within 6 weeks of delivery
no proteinuria or other symptoms of PET

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the risks of PIH

A

(better outcomes than PET)
15% progress to PET
recurrence high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the features of pre eclampsia

A

hypertension
proteinuria (>0.3g/l)
oedema

is a multisystem disorder so can present in many ways- absent of any of these symptoms does not exclude diagnosis

may be asymptomatic at time of first presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what systems does pre eclampsia affect

A

diffuse vascular endothelial dysfuntion= widespread circulatory disturbance:

  • renal (AKI/ failure)
  • hepatic
  • cardiovascular
  • haematology (HELLP)
  • CNS (seizures)
  • placenta (risk of IUGR, abruption, still birth, IUD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the classifications of pre-eclampsia

A

early (<34 weeks):
uncommon
associated with extensive villous and vascular lesions of the placenta
higher risk of maternal and fetal complications

late (>/=34 weeks): 
most common 
minimal placental lesions 
maternal factors (esp metabolic syndrome and pre existing 
hypertension) have important role 
follows more benign course
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

in pre eclampsia when do most cases of eclampsia/ maternal deaths occur

A

in late disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the pathogenesis of pre eclampsia

A

genetic/ environmental predisposition

1.abnormal placental perfusion causing placental ischaemia:
-abnormal placental and trophoblast invasion
-failure of vascular remodelling (Spiral arteries fail to adapt to become high capacitance, low resistance vessels- usually have smooth muscle layer removed and dilate but in pre eclampsia this doesnt happen and vessels remain narrow and highly resistant)
-Placental ischaemia = widespread endothelial damage and dysfunction by releasing pro inflammatoru proteins that activate endothelium:
increase Capillary Permeability
increased Expression of CAM
increased Prothrombotic Factors
increased Platelet aggregration
Vasoconstriction (causes kidneys to retain more water)

  1. maternal syndrome- an anti-angiogenic state associated with endothelial dysfunction
    - hypertension (due to vasoconstriction and water retention)
    - oedema (increased vascular permeability)
    - proteinuria (kidney damage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the HELLP syndrome in pre eclampsia

A 
due to endothelial dysfuntion and vasospasm:
Heamolysis (due to thrombi in vessels)
Elevated 
Liver enzymes 
Low 
Platelets (used up to form thrombi)

develops in 10-20% of women with severe pre eclampsia/ eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what maintains endothelial health in normal pregnancy

A

VEGF And TGF- β 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is there an imbalance of in PET

A

angiogenic and antiangiogenic factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the features of liver disease in PET

A

epigastric/ RUQ pain
abnomal liver enzymes
hepatic capsule rupture
HELLP syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what do signs of liver disease in PET suggests

A

its severe/ in late stages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is placental abruption

A

premature separation of the placenta causing painful antepartum haemorrhage - may be first presentation of PET

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the SYMPTOMS of PET

A 
headache 
visual disturbance 
epigastric/ RUQ pain (liver)
nausea/ vomiting 
rapidly progressing oedema (rings getting stuck on)

presentations will vary in timing, progression and order of symptoms between patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the SIGNS of pre eclampsia

A 
hypertension 
proteinuria
oedema 
abdominal tenderness 
oedema 
abdominal tenderness 
disorientation 
small for dates fetus 
IUD
hyper reflexia/ involuntary movements/ clonus
26
Q

what type of haemorrhage will a low lying placenta cause

A

painless antepartum haemorrhage

27
Q

what Ix into PET

A

U&Es
serum urate (one of first things you see is rise in serum urate)
liver function tests (look for HELLP syndrome)
FBC (haemolysis and thrombocytopenia- low platelets)
coagulation screen
urinalysis for protein creatinine ratio (>30 significant)
cardiotocography
USS for fetal assessment

28
Q

what is the management plan for hypertension in pregnancy

A

assess risk at booking
if HTPx <20 weeks look for secondary cause
antenatal screening- BP, urine, maternal uterine artery doppler
treat hypertension
maternal and fetal surveillance
plan for/ time delivery

29
Q

what are the risk factors for PET

A 
maternal age (<20/ >35)
maternal BMI (higher)
FMHx
parity (higher if first pregnancy) 
multiple pregnancy 
previous PE
birth interval >10 years 
molar pregnancy/ triploidy 
pre existing medical Hx inc HPTx, diabetes, APS, thrombophilia, autoimmune disease

mutliparous women develop more severe disease

30
Q

what is early severe hypertension in pregnancy strongly associated with

A

molar pregnancy

31
Q

what are the medical risk factors for PET

A 
Pre-existing renal disease
Pre-existing hypertension
Diabetes (pre-existing/gestational)
Connective tissue disease
Thrombophilias (congenital / acquired. = anything that makes you more like to clot, acquired more common (e.g. APS) associated with placenta thrombosis)
32
Q

what can be given to prevent PET

A

low dose aspirin 150mg

commence before 16 weeks

33
Q

who should take low dose aspirin to prevent PET

A 
high risk women: 
-renal, DM, APS, multiple risk factors, previous PET
-two moderate risk factors 
or
-one high risk factor
34
Q

what investigation can predict PET

A

maternal uterine artery doppler
-measures resistance in spiral vessels (should go from high resistance and low capacity before preg to low resistance high capacity during preg)

35
Q

what are the possible findings on a MUAD

A

normal= low resistance wave form

high resistance wave form= low flow in diastole due to high resistance in placenta = increase surveillance

36
Q

when should you refer a women to an antenatal day care unit

A

if BP >/= 140/90
++ proteinuria
++ oedema
symptoms (especially persistent headache)

37
Q

when should you admit a pregnant women with worries of PET

A

BP >170/110 OR >140/90 with (++) proteinuria

Significant symptoms - headache / visual disturbance / abdominal pain

Abnormal biochemistry

Significant proteinuria - >300mg / 24h

Need for antihypertensive therapy

Signs of fetal compromise

38
Q

what inpatient assessment is done for inpatient PETs

A 
4 hourly BP
daily urinalysis 
input/ output fluid balance chart
urine PCR if proteinuria on urinalysis 
bloods- FBC, U&amp;Es, urate, LFTs, minimum 2x per week
39
Q

what are the rules for treating HTPx in pregnancy

A

treat regardless of cause
usually treat if >150/100
BP>/= 170/100 requires immediate emergency Tx
dont lower BP too much as HPTx is whats keeping blood flow through placenta - might cause underperfusion and fetal distress

40
Q

does treating BP reduce risk of PET

A

no as underlying process still ongiong

41
Q

what BP should you aim for in pregnancy

A

140-150/90-100 mmHg

42
Q

with MAP >/=150 mmHg what is there significant risk of

A

cerebral haemorrhage

43
Q

what is the treatment for hypertension in pregnancy

A 
methyldopa (alpha agonist) 250mg bd- 1g tds 
labetolol (alpha and beta antagonist 100mg bd- 600mg qid
nifedipine SR (Ca channel antagonist) 10mg bd- 40mg bd

2nd line:
hydralazine (vasodilator) 25 mg tds - 75 qid
doxazocin (alpha antagonist) 1mg od- 8mg bd

44
Q

what hypertensives should you avoid in pregnancy

A

diuretics and ACEi

45
Q

what is methyldopa CI in

A

depression

46
Q

what is labetolol CI in

A

asthma (is an alpha and beta blocker)

47
Q

are the antihypertensive drugs okay to breastfeed with

A

yes- except from doxazocin

48
Q

how can you survey the fetus in a hypertensive mother

A

monitor fetal movements (can feel from 20 weeks, should have felt by 24 weeks)
CTG daily
USS- biometry (abdo circumference), amniotic fluid index (marker of fetal renal function), umbilical artery doppler (assess resistance within fetal circulation)

49
Q

what are the possible results of a fetal umbilical artery doppler

A

normal
absent end diastolic flow
reversed end diastolic flow= high resistance, most severe, pre terminal sign, have 4 days to deliver

50
Q

what rules for delivery in PET

A

Mother must be stablised before birth
Consider expectant management if pre-term
Steroids- prevent resp morbidity (2 doses 24hrs apart)
Most women delivered within 2 weeks of diagnosis
Mode of birth dependent on gestation, parity, maternal/fetal condition, maternal preference
aim for vaginal
epidural anaesthesia - lowers maternal BP
continuous fetal monitoring
avoid ergometrine (given to prevent haemorrhage but is a hypertensive)
caution with IV fluids (pulmonary oedema)

51
Q

what are indications for birth in PET

A 
term gestation 
inability to control BP 
rapidly deteriorating biochemistry/ haematology 
eclampsia (had an eclamptic seizure)
other crisis
fetal compromise (abnormal USS/CTG)
52
Q

what possible crises can occur in PET

A 
eclampsia
HELLP syndrome 
pulmonary oedema 
placental abruption 
cerebral haemorrhage 
cortical blindness 
disseminated intravascular coagulopathy
acute renal failure 
hepatic rupture
53
Q

what is eclampsia

A

tonic clonic seizure occuring with features of pre eclampsia

54
Q

when do eclamptic seizures occur

A

> 1.3 will occur before onset of hypertension/ proteinuria
antepartum 38%
intrapartum 16%
post partum 44%

55
Q

who is more likely to get eclampsia

A

teenagers

56
Q

what is the management of severe PET/ eclampsia

A

control BP (IV labetolol or IV hydralazine)
stop/ prevent seizures
fluid balance
delivery

57
Q

what is the seizure treatment/ prophylaxis in eclampsia

A

magnesium sulphate
loading dose: 4g IV over 5 minutes
maintenance dose: IV infusion 1g/hr

if further seizures 2g
if persistent seizures consider diazepam 10mg IV

58
Q

what is the main cause of maternal death in PET

A

pulmonary oedema

59
Q

what cause pulmonary oedema in pregnancy

A

capillary leak, fluid overload, cardiac failure

60
Q

what test if you are worried about renal function in PET

A

urine osmolality

61
Q

what fluid balance volume for PET

A

80 ml/h

safer to give less as risk of pulmonary oedema

Reproduction (51 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions