Hypertension in Pregnancy Flashcards
define
BP of 140/90mmHg or more on 2 occasions or 160/110 once or if raised >30/15 since 1st trimester
types of hypertension in pregnancy
pre-existing
pregnancy induced hypertension (PIH)
pre-eclampsia
when does PIH happen?
2nd half of pregnancy
when should PIH resolve?
within 6 weeks of delivery
how do you distinguish PIH from pre-eclampsia?
proteinuria
oedema
what is pre-eclampsia?
diffuse vascular endothelial dysfunction with widespread circulatory disturbance
classification of pre-eclampsia
- early= <34 weeks
2. late = >34 weeks
causes of pre-eclampsia
genetics
environment
damaged placenta releases factors into the circulation that causes PET
systemic presentations of pre–eclampsia
- liver disease (HELLP syndrome)
- placental disease
presentation of HELLP syndrome
haemolysis
elevated liver enzymes
low platelets
presentation of placental disease
headache
visual disturbance
RUQ pain
N&V
risks with placental disease
FGR
placental abruption
intrauterine death
cerebral irritation in PET
confused
can’t sit still
brisk reflexes
management options for hypertension in pregnancy
methyldopa labetolol nifedipine hydralazine doxazocin
action of methyldopa
alpha agonist
when to avoid methyldopa?
depression
mechanism of action of labetolol
alpha and beta antagonist
when is labetolol contraindicated?
asthma
action of nifedipine
Ca channel antagonist
BP aim
130/85 (don’t be too aggressive)
action of hydralazine
vasodilator
mechanism of action of doxazocin
alpha antagonist
when should doxazocin be avoided?
breastfeeding
management of placental disease
low dose aspirin commencing before 16 weeks at 150mg
what to avoid in labour if hypertension?
ergometrine as raises BP
avoid diuretics and ACEI
what is eclampsia?
tonic-clonic seizure occuring with features of pre-eclampsia
who is eclampsia more common in?
teenagers
management of eclampsia
control BP= IV labetolol
stop seizure= magnesium sulphate IV
fluid restriction if pulmonary oedema
deliver baby
