Hypertension in pregnancy Flashcards
What changes in blood pressure are normal in pregnancy?
Drop to a nadir during second trimester, by about 30/15, return to normal by term.
What is the definition of pregnancy-induced hypertension?
BP >140/90 after 20wks.
What are the causes of pregnancy-induced HTN?
Pre-eclampsia.
Transient HTN.
Gestational HTN.
What is the increased risk of pre-eclampsia from existing HTN?
6 times the risk.
What changes take place in pre-eclampsia? What effects do they have?
Exaggerated inflammatory response causing:
Vasospasm: HTN, eclampsia, liver damage.
Increased capillary permeability: proteinuria, oedema.
Clotting dysfunction.
How common is pre-eclampsia in primips? And what is the recurrence rate?
6% in primips. 15% recur.
What are the classifications of pre-eclampsia?
Mild: proteinuria and HTN 140/90-159/109.
Moderate: proteinuria and HTN >160/110, no maternal complications.
Severe: proteinuria and any HTN <34wks, or maternal complications.
What are the risk factors for pre-eclampsia?
Nulliparity.
Previous / FH pre-eclampsia.
Long gap between pregnancies.
Obesity.
Extremes of age.
Microvascular disease (chronic HTN, chronic renal disease, sickle cell, DM, antiphospholipid).
Large placenta (twins, hydrops, molar pregnancy).
What level of proteinuria is considered significant?
Dipstick >=2.
PCR >30.
What is HELLP?
Haemolysis.
Elevated liver enzymes.
Low platelets.
Also DIC, liver failure and liver rupture.
What features, if any, does pre-eclampsia present with?
Headache.
Drowsiness.
Visual disturbances.
Nausea / vomiting.
Epigastric pain (late).
What are the maternal complications of pre-eclampsia?
Eclampsia (grand mal seizure).
Cerebrovascular haemorrhage (autoregulation failure above 140mmHg).
HELLP.
Renal failure.
Pulmonary oedema.
What are the fetal complications of pre-eclampsia?
if <34wks: IUGR.
Term: increased morbidity and mortality.
All gestations: risk of abruption.
What is the treatment for pre-eclampsia?
Delivery!
How do you manage a pre-eclamptic?
Initially: admit to day assessment unit for tests.
No proteinuria, mild HTN: monitor twice weekly.
Proteinuria +- severe HTN: admit.
