Hypertension in pregnancy I Flashcards
What types of hypertension in pregnancy are there?
Gestational HTN
Pre-eclampsia + eclampsia
Chronic HTN
Pre-eclampsia superimposed upon chronic HTN or renal disease
How is gestational HTN defined?
New onset HTN after 20 weeks
Systolic > 140
Diastolic > 90
No or little proteinuria
Most women with gestational HTN develop pre-eclampsia. True or false?
False
Only 25%
What is meant by chronic HTN?
She had it before pregnancy
Sometimes it’s only picked up during pregnancy
What’s the difference between pre-eclampsia and eclampsia?
Pre-eclampsia can progress to eclampsia
Eclampsia is very serious
What is pre-eclampsia?
When does it occur?
A systemic syndrome that causes hypertension, proteinuria and other symptoms
Occurs after 20 weeks
What causes pre-eclampsia?
Failure of remodelling of spiral arteries
They should be remodelled so they’re not affected by vasoconstrictors, protecting placental blood flow
In pre-eclampsia they weren’t.
3 classifications of pre-eclampsia + eclampsia?
Mild pre-eclampsia
Severe pre-eclampsia
Eclampsia
Clinical features of pre-eclampsia?
HTN
Proteinuria
In mild pre-eclampsia they can be asymptomatic
In more severe disease:
Oedema
Oliguria
CNS: headaches, visual, mental state changes, ankle clonus
Pulmonary oedema
Epigastric, RUQ pain
When does pre-eclampsia become eclampsia?
When there are T-C seizures as well as pre-eclampsia
Investigations for pre-eclampsia?
Bloods:
- haemoglobin
- LFTs, clotting
- uric acid
- U+E
Check fetus growth
RUQ pain
Fundoscopy
Neuro exam
Management of pre-eclampsia?
The only cure is to deliver the baby
But if too pre-term
- monitor closely
- anti-convulsive
- anti-hypertensive
Follow up care
What anti-convulsive would you give in pre-eclampsia or eclampsia?
Magnesium sulphate
How would you know if a woman with chronic or gestational hypertension had developed pre-eclampsia?
If there was new onset proteinuria
Or if they already had proteinuria, if it suddenly increased or BP increased
Which anti-hypertensives are used in pre-eclampsia?
Hydralazine
Labetalol
Nifedipine (with caution)
