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YEAR 3 REPRO > hypertension in pregnancy > Flashcards

hypertension in pregnancy Flashcards

1
Q

what is needed to diagnose hypertension in pregnancy

A

bp > = 140/90 on 2 occasions
or
>= 160/110 on 1 occasion
or an increase from booking readings of > 30/15

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2
Q

what is pre-existing hypertension

A

diagnosis prior to pregnancy

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3
Q

if hypertension is found early in pregnancy what is it most likely to be

A

pre-existing

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4
Q

what are some risks of pre-existing hypertension

A

PET
IUGR
abruption

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5
Q

what is the time scale of pregnancy induced hypertension

A

from 20 weeks of pregnancy

resolves within 6 weeks of delivery

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6
Q

would you get proteinuria with PIH

A

no

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7
Q

is the rate of recurrence of PIH high or low

A

high

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8
Q

what are the 3 features of pre-eclampsia

A

hypertension
proteinuria
oedema

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9
Q

what is classed as proteinuria in pre-eclampsia

A

> 0.3g/L
or
0.3g/24hr

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10
Q

do all people with pre-eclampsia have oedema

A

no

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11
Q

can pre-eclampsia be asymptomatic

A

at time of presentation yes

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12
Q

why does BP fall in pregnancy initially

A

vasodilation

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13
Q

what is an organ largely affected by pre-eclampsia

A

liver

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14
Q

when does pre-eclampsia occur

A

after 20 weeks

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15
Q

what is the presentation of pre-eclampsia (9)

A 
hypertension
headache (cerebral oedema)
visual disturbance
papilloedema
RUQ/epigastric pain
sudden onset oedema
N+V
hyperreflexia, clonus 
platelets < 100 x 10^6/L, abnormal liver enzymes or HELLP syndrome
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16
Q

what is HELLP syndrome

A

haemolysis
elevated liver enzymes
low platelets
high morbidity/mortality

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17
Q

what is early pre-eclampsia

A

< 34 weeks

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18
Q

what is late pre-eclampsia

A

> = 34 weeks

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19
Q

what placental disease can pre-eclampsia cause

A

FGR
placental abruption
intrauterine death

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20
Q

what kind of pre-eclampsia is more common

A

late

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21
Q

what is early pre-eclampsia assoc. with re the placenta

A

extensive villous and vascular lesions

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22
Q

which kind of pre-eclampsia has a higher risk of complications

A

early

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23
Q

are there placental lesions in late pre-eclampsia

A

minimal

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24
Q

what are some RFs for pre-eclampsia

A 
HT disorder in previous pregnancy/HT 
CKD
CTD
thrombophilias 
AID e.g. SLE or APS
DM (type 1 or 2)
first pregnancy
age 40 +
pregnancy interval of 10+ years
BMI of 30 +
fmhx of PET
multiple pregnancy
previous PE
molar pregnancy/triploidy
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25
Q

what can pre-eclampsia develop into if poorly controlled

A

eclampsia

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26
Q

what is the pathogenesis of pre-eclampsia generally

A

defective deep placentation - injured placenta then releases factors into the maternal circulation that induces pre-eclampsia

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27
Q

what is the first stage of pre-eclampsia pathophysiology

A

abnormal placental perfusion leading to placental ischaemia

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28
Q

what is the second stage of pre-eclampsia pathophysiology

A

maternal syndrome - anti-angiogenic state assoc. with endothelial dysfunction

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29
Q

what kind of state is maternal syndrome in pre-eclampsia

A

anti-angiogenic

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30
Q

pre-eclampsia involves abnormal placentation and ____ invasion

A

trophoblast

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31
Q

in pre-eclampsia _____ arteries fail to become low resistance leading to _____ damage and placental ischaemia

A

spiral arteries - fail to lose muscle layer

widespread endothelial damage

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32
Q

in normal pregnancy what maintains endothelial health

A

VEGF

TGF-B1

33
Q

what is secreted in excess in pre-eclampsia and antagonises VEGF and TGF-B1

A

sFit1

sEng

34
Q

what are the symptoms of pre-eclampsia

A 
headache 
visual disturbance 
epigastric/RUQ pain
N+V
rapidly progressive oedema
35
Q

what are the signs of pre-eclampsia

A 
hypertension
proteinuria
oedema
abdominal tenderness
disorientation
SGA fetus
intra-uterine death
hyperreflexia/involuntary movements/clonus
36
Q

what what is the main cause of death in pre-eclampsia

A

pulmonary oedema

37
Q

what investigations would you do for pre-eclampsia

A 
BP
U+E
serum urate
LFTs
FBC
coag screen
urine - PCR
CTG
US
38
Q

___ flow and ____ resistance are signs on uterine artery doppler of pre-eclampsia

A

low flow

high resistance

39
Q

with hypertension before 20 weeks what should you look for

A

secondary cause

40
Q

multiparous women develop more/less severe disease

A

more

41
Q

how does aspirin work

A

inhibits cyclo-oxygenase preventing TXA2 synthesis

42
Q

when should aspirin be commenced in high risk women

A

at 12 weeks (before 16 weeks)

43
Q

what is the dose of aspirin in pre-eclampsia high risk patients

A

150mg

44
Q

what would be seen on a maternal uterine artery doppler in pre-eclampsia

A

notching

45
Q

when should you refer a patient to AN DCU

A

BP > 140/90
++ proteinuria
^^ oedema
symptoms esp a persistent headache

46
Q

over what BP should a patient be admitted

A

170/110
or
140/90 with ++ proteinuria

47
Q

what are other indicators that the patient should be admitted

A

signs of fetal compromise
significant proteinuria (> 300)
abnormal biochemistry
significant symptoms

48
Q

hypertensive inpatient:

how often to check BP

A

4 hourly

49
Q

hypertensive inpatient:

how often is urinalysis done

A

daily

50
Q

MAP > what is a significant risk of cerebral haemorrhage

A

150

51
Q

a bp over what requires immediate treatment

A

170/110

52
Q

does control of blood pressure reduce the risk of developing pre-eclampsia

A

no

53
Q

what drugs are used in the treatment of pre-eclampsia

A 
methyldopa
labetolol
nifedipine
hydralazine 
doxazocin
54
Q

what anti-hypertensive drugs should be avoided in pregnancy

A

ACEI
ARB
diuretics

55
Q

what is methyldopa

A

centrally acting alpha agonist

56
Q

when is methyldopa contraindicated

A

depression

57
Q

what is labetolol

A

alpha and beta antagonist

58
Q

when is labetolol contraindicated

A

asthma

59
Q 
are the following drugs ok in breastfeeding
methyldopa
labetolol
nifedipine
hydralazine 
doxazocin
A

all yes except doxazocin

60
Q

what is nifedipine

A

calcium channel antagonist

61
Q

what is hydralazine

A

vasodilator

62
Q

what is doxazocin

A

alpha antagonist

63
Q

what is the only definitive cure for pre-eclampsia

A

delivery

64
Q

if a women is going to deliver baby preterm what should she be given and why

A

steroids - encourage surfactant production

65
Q

pre-eclampsia increases the risk of developing what

A 
eclampsia
neonatal death
IVH
NEC
placental abruption
cerebral haemorrhage
cortical blindness
DIC
AKD
hepatic rupture
66
Q

what is eclampsia

A

tonic-clonic grand mal seizure occurring with features of pre-eclampsia

67
Q

eclampsia is more common in older women/teenagers

A

teenagers

68
Q

hyperreflexia and clonus are examples of upper/lower MN signs

A

upper

69
Q

umbilical artery doppler can be used to assess

A

blood flow in patient with known pre-eclampsia

70
Q

how is severe PET/eclampsia managed

A

IV labetolo / IV hydralazine

IV magnesium sulfate

71
Q

what does IV magnesium sulfate do in eclampsia/severe PET

A

stops/prevents seizures

72
Q

what is the loading dose of magnesium sulfate

A

4g IV over 5 minutes

73
Q

what is the maintenance dose of magnesium sulfate

A

IV infusion 1g/hr

74
Q

how much magnesium sulfate should be administered if another seizure occurs

A

2g

75
Q

what can be given if persistent seizures

A

diazepam 10mg IV

76
Q

why are fluid challenges potentially dangerous in PET/eclampsia

A

main cause of death is pulmonary oedema

77
Q

what kind of pain relief should be used in PET delivery

A

epidural

78
Q

what drug should be avoided in delivery of PET

A

ergometrine

79
Q

how should a baby be delivered if eclampsia

A

vaginal if fully dilated otherwise c section probably fasted

YEAR 3 REPRO (11 decks)

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