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MRCOG Antenatal Part 2 Revision - Hay > Hypertension in pregnancy - Busy SpR + NICE > Flashcards

Hypertension in pregnancy - Busy SpR + NICE Flashcards

1
Q

What’s the most common cause of death in women with PET/eclampsia?

A

Cerecrovascular events - ICH

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2
Q

What % of women with PET delivery before
- 34 weeks
- 37 weeks

A
  • 10% before 34 weeks
  • 50% before 37 weeks
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3
Q

What is the recurrence risk of PIH/PET if had any previous hypertension?

A

1 in 5

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4
Q

If previous any HTN in this or previous pregnancy
- Risk gestation HTN
- Risk PET

A
  • Gestational 9% (1/11)
  • PET 14% (1/7)
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5
Q

If previoud PET, risk of
- Gestational HTN
- PET
- Chronic HTN

A
  • 6-12% 1/8
  • 16% 1/6 (if 28-34 33%1/3)
  • 2% 1 in 50
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6
Q

If PET <34/40 risk of PET in this pregnancy?

A

1/3
Risk greater if >10 year interval

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7
Q

If previous gestational HTN
- Risk gestation HTN
- PET
- Chronic HTN

A

11-15% 1/7
PET: 7% 1/14
Chronic 3% 1/34

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8
Q

Risk chronic HTN if previous
- PET
- PIH

A
  • PET 1 in 50 2%
  • PIH 1 in 34 3%
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9
Q

According to NICE which high risk women should take 150mg aspirin from 12 well?

A

hypertensive disease during a previous pregnancy

chronic kidney disease

autoimmune disease such as SLE or antiphospholipid syndrome

type 1 or type 2 diabetes
chronic hypertension

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10
Q

According to NICE what are the moderate risk factors for PET, if more than one should take aspirin

A

first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
BMI of 35 kg/m2 or more at first visit
family history of pre-eclampsia
multiple pregnancy

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11
Q

What BP os considered severe HTN?

A

> 160/110 - these women should be admitted to hospital

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12
Q

According to NICE how to manage someone with BP >160/110.
-Target BP
- Frequency observations
- Fetal assessment
-Frequency bloods/urine dip

A
  • admit to hospital
  • Give antihypertensives aiming 135/85
  • Every 15-30 mins until BP below 160/110
  • Daily urine dip and bloods as inpatient
  • PLGF on 1 occasion
  • Fetal auscultation at every visit, USS 2 weekly, CTG as Dx
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13
Q

According to NICE how to manage 140/90-159/109
- How often urine/bloods
- PLGF ration
- Fetal assessment

A

Treat if BP remains >140/90 aiming 135/85
BP and urine 1-2 weekly
Bloods at presentation then weekly
PLGF ratio x 1
Fetal USS 2-4 weekly, fetal auscultation at every AN

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14
Q

When to reduce anti-hypertensives

A

<130/80

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15
Q

For women with PIH postpartum, when should their BP be measured?

A

Day 2 after birth
1 x between day 3-5
As clinically indicated if antihypertnesices change

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16
Q

What medication should be offered 1st line to treat BP in postnatal period (non black women)?

A

Enalapril - monitor renal function and K

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17
Q

What medication should be offered 1st line to treat BP in postnatal period for black women?

A

Nifedipine or
amlodipine if used before

If not controlled use combination

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18
Q

When does NICE say need to admit for PET?

A

Creatinine >90
ALT >70 x upper limit
Fall in platelets
Signs eclampsia/pulmonary oedema
Suspected Fetal compromise

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19
Q

What is the dose of magnesium sulphate given to women to previous eclamptic seizure?

A

IV 4g loading 5-15 mins, 1g/hour for 24 hours (continue 24 hours after last seizure)

Recurrent first, further 2-4g IV

20
Q

If PET and is only passing 5-10ml/hour of urine, what should the fluid input be?

A

80ml/hr

21
Q

What feature may mean you need to deliver <37 weeks in PET?

A

inability to control BP despite using 3 or more classes of antihypertensives in appropriate doses
SPO2 less than 90%
progressive deterioration in liver function, renal function, haemolysis, or platelet count
ongoing neurological features, such as severe intractable headache, repeated visual scotomata, or eclampsia
placental abruption
reversed end-diastolic flow in the umbilical artery doppler, a non-reassuring CTG, or stillbirth.

22
Q

Postpartum, PET and no antihypertensives
when should be BP be measured?

A

4 x day as inpatient
1 x Day 3-5
Alt dats until normal, if abnormal day 3-5

Commence antihypertensives if BP >150/100 on 2 occasions

23
Q

Postpartum, PET on antihypertensives:

A

4 x day inpatient
1-2 days for 2 weeks until off treatment

Consider reducing if <140/90, reduce if <130/80

24
Q

If patient on methyldopa for PET when should it be chanced

A

Within 2 days

25
Q

If PET when should see GP

A

2 and 6 weeks

26
Q

What class of receptors does labetolol block?

A

Selective, competitive alpha-1-adrenergic
Non-selective, competitive, beta-adrenergic

27
Q

What effect dose labetolol have on the cardiovascular system?

A

Dose-related fall in BP without reflex tachycardia, no sig reduction in HR
Elavated renin

28
Q

Half life of IV and PO labetolol

A

IV 5.5 hrs
PO 6-8hrs

29
Q

Is the half life of labetolol effected by decreased liver or renal function?

A

no

30
Q

How is labetolol metabolised?

A

Conjugated with glucuronides which are exerted in urine and bile

31
Q

Does labetolol cross the placenta?

A

Yes

32
Q

In PET what happed to sFLT-1 levels

A

They rise

33
Q

In PET what happed to PIGF levels

A

Lower

34
Q

In normal pregnancy when does the PIGF level peak?

A

26-30 weeks, then decreases

35
Q

What is the sFLT/PIGF ratio used for?

A

To help rule out pre-eclampsia

36
Q

Cut of values for sFlt-1/PIGF ratio 20-33+6 weeks

A

Rule out <33
Rule in >85

37
Q

Cut of values for sFlt-1/PIGF weeks 34 weeks - delivery

A

Rule out <33
Rule in >110

38
Q

If PET and BP >160/110. How to manage:
- frequency BP
- Urine dip
- PET bloods
- Fetal assessment

A

Admit
Treat BP aiming 135/85
BP every 15-30 mins until >160/110, then 4 x day as inpatient
Only repeat urine dip if clinically indicated
PET bloods 3 x week
USS 2 x weekly, FH each ANC

39
Q

PET and BP 140/90-159/109

A

Admit if clinical concerns mother/baby, high score on full PIERS PREP-S
Tx if BP remains >140/90, aim 135/85
BP every 48 hrs, unless admitted
PET bloods 2 x weekly
USS 2 weekly, FH at each ANC

40
Q

When to consider delivery <37/40 for PET>

A

Inability to contol BP 3+ antihypertensives
Pulse Oximeter 90%
Progressive deterioration in bloods
Ongoing neurological - headache
Abruption
Reversed end diastolic flow in UAD, non reassuring CTG, still with

Senior decision

41
Q

PET no antihypertensives, when to offer PN BP measurement

A

BP 4 x a day as inpatient
1x Day 3-5 (if abnormal alt days_
Tx if >150/100

42
Q

PET on antihypertensives, when to offer PN BP measurement

A

BP 4 x a day as inpatient
Every 1-2 days for up to 2 weeks
Reduce if <130/80
2 week GP and 6-8 weeks

43
Q

In PET if ongoing proteinuria at 6-8 week GP check

A

Review again with GP or specialist in 3 months

44
Q

When to consider MgSU

A

Severe PET and birth within 24hrs

Consider 1+
- Worsening severe headache
- Visual scotomata
- N+V
- Epigastric pain
- Oliguria + severe HTN
- Progressively worsening bloods

45
Q

Dose of MgSu

A

4g 5-15mins
1g/hr in 24 hours

46
Q

How much fluid restriction

A

80ml/hr unless ongoing losses (haemorrhage)

47
Q
A

MRCOG Antenatal Part 2 Revision - Hay (72 decks)

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