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1. Reproduction > Hypertension in Pregnancy > Flashcards

Hypertension in Pregnancy Flashcards

1
Q

What % of primigravid women are affected by mild pre eclampsia?

A

10%

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2
Q

How does the plasma volume change in pregnancy?

A

increases 45%

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3
Q

How does the cardiac output change in pregnancy?

A

increases 30-50%

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4
Q

How does the stroke volume change in pregnancy?

A

increases 25%

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5
Q

How does the heart rate change in pregnancy?

A

increases 15-25%

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6
Q

How does the peripheral vascular resistance change in pregnancy?

A

decreases 15-20%

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7
Q

How is hypertension in pregnancy defined?

A

> /= 140/90 on 2 occasions OR
160/110 once OR
30/15 compared to first trimester reading

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8
Q

If a woman has hypertension in the first half of pregnancy, what is it likely to be?

A

undiagnosed hypertension

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9
Q

What are the risks of pregnancy for those with pre existing hypertension?

A

2x increase in PET
intrauterine growth restriction
abruption

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10
Q

What is pregnancy induced hypertension?

A

second half of pregnancy

resolved within 6 weeks of delivery

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11
Q

In PIH - what % progresses to pre eclampsia?

A

15%

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12
Q

What are the symptoms/signs of pre eclampsia?

A

hypertension
proteinuria (>/= 0.3g/l)
oedema

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13
Q

Can PET be asymptomatic?

A

YES

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14
Q

What is early PET?

A

<34 weeks

higher risk of maternal and foetal complications

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15
Q

What is late PET?

A

> 34 weeks
most common
more likely to lead to eclampsia and maternal death

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16
Q

What is seen in the placenta in early PET?

A

extensive villious and vascular lesions

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17
Q

What is seen in the placenta in late PET?

A

minimal placental lesions

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18
Q

How is the placenta affected in PET, and why?

A

abnormal placental perfusion leads to ischaemia -> endothelial dysfunction
endothelial activation leads to increased capiliary permeability, expression of CAM, prothrombic fators, platelet aggregation and vasoconstriction

19
Q

What puts you at a higher risk of PET?

A

x3 risk if mother or sister had it

20
Q

What is HELLP syndrome?

A

PET induced liver disease

21
Q

What are the features of HELLP syndrome?

A

HELLP: haemolysis, elevated liver enzymes, low platelets

Epigastric/RUQ pain
high morbidity/mortality

22
Q

What is PET induced placental disease?

A

fetal growth restriction
placental abruption
intrauterine death

23
Q

What are the symptoms of hypertension?

A 
headache
visual disturbance
epigastric/RUQ pain
rapidly progressing oedema
nausea/vomiting
visual disturbance
24
Q

What investigations should you do for a mother with hypertension?

A

U+Es, FBC, coagulation scree, LFTs, serum urate, protein creatinine ratio, CTG
USS foetus

25
Q

How do you manage a mother with hypertension?

A

hypertension <20 weeks - look for secondary cause
treat hypertension
antenatal screening - BP, urine, MUAD (maternal uterine artery doppler) at 20-24 weeks
time the delivery

26
Q

What are the risk factors that cause hypertension?

A 
age >40
BMI >30
FH - 40% if sister, 25% if mother
first pregnancy - 2-3x
twins - 2x
previous PE - 7x
birth interval >10 yrs x2
molar pregnancy/triploidy
pre existing renal disease/hypertension
diabetes
connective tissue diseases
thrombophillia
27
Q

What is the action of aspirin?

A

inhibits COX2 which prevents TXA2 synthesis

28
Q

When should low dose aspirin be commenced?

A

before 16 weeks

29
Q

How can LDA help PET?

A

causes a 15% reduction in it

30
Q

If you have 2 of these moderate risk factors you should take LDA 75mg/day from 12weeks-> birth. What are they?

A 
first pregnancy
age >40
pregnancy interval >10years
BMI >/= 35
FH of PET
multiple pregnancy
31
Q

If you have 1 of these high risk factors you should take LDA 75mg/day from 12 weeks-> birth. What are they?

A 
hypertensive disease in previous pregnancy 
chronic kidney disease
autoimmune disease
T1DM or T2DM
chronic hypertension
32
Q

When should you admit someone to hospital with hypertension?

A

if BP >/= 170/110 OR
>/= 140/90 with ++ proteinuria
and significant symptoms/signs of foetal comprimise

33
Q

What does MAP >/= 150 put you at risk of?

A

cerebral haemorrhage

34
Q

What should a pregnant womans BP aims be?

A

140-150/90-100

35
Q

What are 1st line antihypertensives used in pregnancy?

A

Methyl dopa - alpha agonist
Labetalol - alpha and beta agonist
Nifedipine - ca channel blocker

36
Q

What are 2nd line antihypertensives used in pregnancy?

A

Hydralazine - vasodilator

Doxazocin - alpha antagonist

37
Q

What antihypertensive drug is not safe for breastfeeding?

A

Doxazocin + Methyl dopa

38
Q

When is Labetalol contraindicated?

A

asthma

39
Q

When should you aim to deliver a baby after a PET diagnosis?

A

within 2 weeks

40
Q

What is Eclampsia?

A

tonic clonic seizure occuring with features of PET - many have seizures before the onset of proteinuria/hypertension

41
Q

When does eclampsia most commonly occur?

A

post partum - 44%

antepartum - 38%

42
Q

Who is most likely to have eclampsia?

A

teenagers

43
Q

How do you treat eclampsia?

A

control BP - IV labetalol or hydralazine
seizure treatment - magnesium sulfate IV 4g, if persistent diazepam 10mg IV
fluid balance

44
Q

How should labour be managed in eclampsia?

A

aim for vaginal birth
epidural and control BP
avoid ergometrine
continous foetal monitoring

1. Reproduction (50 decks)

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