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Reproduction and sexual health > Hypertension in pregnancy > Flashcards

Hypertension in pregnancy Flashcards

1
Q

What is the commonest cause of iatrogenic prematurity

A

Pre eclampsia

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2
Q

What BP readings classify as hypertension in pregnancy

A

> = 140/90 mmHg on 2 occasions

>160/110 mmHg once

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3
Q

What are the 3 groups of hypertensive disease in pregnancy

A

Pre-existing hypertension
Pregnancy induced hypertension (PIH)
Pre-eclampsia

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4
Q

When is diagnosis of pre-existing HTN made

A

Prior to pregnancy

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5
Q

When is PIH diagnosed

A

in 2nd half of pregnancy

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6
Q

When does PIH usually resolve by

A

within 6 weeks after delivery

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7
Q

What other symptoms of PIH are there

A

None, only HTN

No proteinuria or other features of pre eclampsia

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8
Q

There is a high rate of recurrence of PIH with future pregnancies, true or false

A

TRUE

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9
Q

What are the key features of pre eclampsia

A

Hypertension
Proteinuria >=0.3g/L
Oedema

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10
Q

Absence of one of the key features of PET rules out the disease, true or false

A

FALSE

PET can present in any way

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11
Q

define pre eclampsia

A

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

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12
Q

Women may be asymptomatic at first presentation of PET, true or false

A

TRUE

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13
Q

what systems are affected in PET

A 
Renal 
Hepatic 
CVS 
Haematology 
CNS 
Placenta 
Pulmonary
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14
Q

What are the classifications of PET

A

Early

Late

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15
Q

Describe early PET

A

<34 weeks
uncommon
associated with placental pathology
higher risks

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16
Q

Describe late PET

A

> = 34 weeks
more common form
tends to be more benign but if severe can increase risk of mortality

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17
Q

What are the 3 factors thought to play a role in the pathogenesis of PET

A

Genetic / environmental predisposition
Stage 1 = failure of placental development –> placental ischaemia
Stage 2 = maternal syndrome, anti angiogenic state

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18
Q

What happens to the spiral arteries in pre eclampsia

A

failure to turn into high capacity low resistance vessels and so get widespread endothelial damage

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19
Q

What is HELLP syndrome

A

Haemolysis
Elevated Liver enzymes
Low Platelets

Epigastric/RUQ pain
hepatic capsule rupture

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20
Q

What are consequences of placental disease in PET

A

FGR
IUD
placental abruption

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21
Q

List symptoms of PET

A 
Headache 
Visual disturbance 
Epigastric/RUQ pain 
N+V 
Rapidly progressive oedema
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22
Q

List signs of PET

A 
HTN 
Proteinuria 
Oedema 
Abdominal tenderness 
Disorientation 
SGA foetus 
IUD 
HYPER REFLEXIA / INVOLUNTARY MOVEMENTS / 
CLONUS
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23
Q

What sign must you check for in all women with PET

A

Hyper reflexia

24
Q

What blood tests and investigations are done in PET

A 
U+E
Serum urate 
LFT 
FBC 
Coagulation screen 
Urinary PCR 
CTG 
USS
25
Q

What is the first biochemical marker seen to rise in PET

A

Serum urate

26
Q

List RF for PET

A 
age >40 
BMI > 30 
FH 
parity - 1st baby 
multiple pregnancy 
previous PE 
>10 year birth interval 
molar pregnancy 
pre existing renal disease 
pre existing hypertension 
Diabetes 
thrombophilias 
CTD
27
Q

What does low dose aspirin do

A

inhibits COX and prevents TXA2 synthesis

28
Q

Who gets LDA

A

high risk women

29
Q

What is the dosing and timing of low dose aspirin

A

150mg started before 16 weeks

30
Q

What is maternal uterine artery doppler MUAD

A

assesses resistance and capacity of spiral arteries

31
Q

What is a normal MUAD

A

low resistance waveform

32
Q

What is an abnormal MUAD

A

high resistance waveform

notching seen

33
Q

MAP >=150mmHg increases risk of cerebral haemorrhage in mother, true or false

34
Q

At what blood pressure level do you treat

A

> =150/110 mmHg

35
Q

What BP level requires immediate treatment

A

> =170/110mmHg

36
Q

controlling BP does reduce the risk of developing PET, true or false

A

FALSE, it does not decrease the risk as the underlying pathology is still going on

37
Q

What anti-hypertensive agents can be used in pregnancy

A 
Labetolol - alpha and beta blocker 
Methyldopa - centrally acting alpha agonist 
Nifedipine - CCB
Hydralazine - vasodilator 
Doxazocin - alpha antagonist
38
Q

In whom is methyldopa contraindicated

A

Those with depression

39
Q

In whom is labetolol contraindicated

A

Those with asthma

40
Q

Is doxazocin safe in breast feeding

41
Q

What is umbilical artery doppler and how does is differ from MUAD

A

Umbilical doppler measure placental flow from foetal aspect
It is done in 3rd trimester
MUAD looks at maternal aspect and is done at 20-24wks

42
Q

What is the only cure for PET

43
Q

What is the benefit of giving steroids to mother for pre term deliveries

A

allows for foetal lung maturation and prevents necrotising enterocolitis (NET)

44
Q

What crises can occur in PET

A 
Eclampsia!
HELLP syndrome 
Pulmonary oedema 
Placental abruption 
Cerebral haemorrhage 
Disseminated intravascular coagulation 
Cortical blindness 
Acute renal failure 
Hepatic failure
45
Q

What is eclampsia

A

tonic clonic seizure occurring with symptoms of pre eclampsia

46
Q

What are the steps in management of eclampsia

A
  1. Control BP - labetolol / hydralazine IV
  2. stop/prevent seizures
  3. fluid balance
  4. deliver baby
47
Q

What is given to stop or prevent eclamptic seizures

A

Magnesium sulphate

48
Q

What is given for persistent eclamptic seizures

A

IV diazepam

49
Q

What is ergometrine and why should it be avoided

A

It causes uterine contractions

It also raises BP

50
Q

risk of magnesium sulphate and the drug to reverse this

A

respiratory depression

calcium gluconate

51
Q

mechanism of action of magnesium sulphate

A

cerebral vasodilator

52
Q

side effects of magnesium sulphate

A 
impending doom 
facial flushing 
heat going up arm 
metallic taste 
N+V
53
Q

Mg SO4 is a CNS depressant, true or false

A

true

may affect maternal and foetal CNS

54
Q

signs of Mg SO4 toxicity

A

absent deep tendon reflexes
slurred speech
RR<10 - resp depression
cardiac arrest

55
Q

management of Mg SO4 toxicity

A 
ABCDE + resus 
stop Mg SO4 
call for help 
ECG 
Mg blood levels
calcium gluconate
56
Q

eclamptic seizures can occur post partum, true or false

Reproduction and sexual health (46 decks)

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