Hypertension In Pregnancy (Pre-existing, PIH, Pre-eclampsia) Flashcards
Hypertension affects 10-15% of all pregnancies. T/F?
True
What is the commonest cause of iatrogenic prematurity?
Pre-eclamspia
Mild pre-eclampsia affects _ of primigravid women and severe pre-eclampsia affects _ of primigravid women.
10% mild,
1% severe
Physiological changes in pregnancy. What increases by 45%? What increases by 30-50%? What increases by 25%? What increases by 15-25%? What decreases by 15-20%? Which one of these steadily rises throughout pregnancy?
Plasma volume by 45%, CO by 30-50%, SV by 25%, HR by 15-25%, Peripheral vascular resistance decreases by 15-20% HR steadily rises
Definition of hypertension in pregnancy? (2)
> 140/90 mmHg on 2 occasions or >160/110mmHg once
3 types of hypertension in pregnancy?
Pre-existing hypertension,
Pregnancy induced hypertension,
Pre-eclampsia
Pre-existing hypertension is usually diagnosed before pregnancy but may be a reprospective diagnosis if what?
If BP has not returned to normal within 3 months of delivery
List 5 secondary causes to consider in pre-existing hypertension?
Renal, Cardiac, Cushing’s, Conn’s, Phaeochromocytoma
List 3 risks of pre-existing hypertension in pregnancy?
Pre-eclampsia risk increased x2,
FGR,
Placental abruption
Pregnancy induced hypertension is diagnosed when?
In second half of pregnancy
Rate of recurrence of PIH is high. However PIH resolves within how long of delivery?
6 weeks
PIH has better outcomes than pre-eclampsia but 15% of PIH progresses to what?
Pre-eclampsia
List 3 signs of pre-eclampsia? However?
Hypertension,
Proteinuria (uPCR > 30),
Oedema,
However - absence of any one of those does not exclude diagnosis!!
90% of cases of pre-eclampsia present when in pregnancy?
> /= 34 weeks AKA late pre-eclampsia so often not associated with placental disease
Pre-eclamspia classified by what pathophysiologically and affects what systems?
Vascular endothelial dysfunction causing widespread circulatory disturbance affecting renal, hepatic, cardiovascular, haematology, CNS or placenta
Pre-eclampsia has a genetic/environmental predisposition. What are the two stages of pre-eclasmpia in terms of pathogenesis?
Stage 1: abnormal placental perfusion causing placental ischaemia,
Stage 2: maternal syndrome in response to placental ischaemia - an anti-angiogenic state associated with endothelial dysfunction
Normally in pregnancy the cytotrophoblast cells invade the tunica media vascular smooth muscle layer of the spiral arteries to allow for what? This does not occur in pre-eclampsia
High capacity, low resistance vessels which increases blood flow
What does the failure of cytotrophoblast/decidual interaction cause?
Oxidative stress and proinflammatory cytokines leads to imbalance with antiangiogenesis and angiogenesis factors
List 8 diff system outcomes of pre-eclampsia
Proteinuria/renal failure, Pancreatitis, Acute fatty liver/liver rupture, IUGR/fetal death/placental abruption, Hypertension, Cardiac failure/pulmonary oedema, Seizure/ICH/blindness, Haemolytic anaemia/thrombocytopaenia
What is HELLP syndrome?
Haemolysis, Elevated Liver Enzymes, Low Platelets - has high morbidity for both baby and mom
What are 3 specific signs of HELLP syndrome?
Epigastric/RUQ pain,
Abnormal liver enzymes
Hepatic capsule rupture
5 common symptoms of pre-eclampsia?
Headahce, Visual disturbance, Epigastric/RUQ, N&V, Rapidly progressive oedema
8 signs of pre-eclampsia?
Hypertension, Proteinuria, Oedema, Abdo tenderness, Disorientation, Hyper-reflexia/involuntary movements/clonus, SGA fetus, Intra-uterine fetal death
Many women with pre-eclampsia are asymptomatic at time of presentation. True/False?
True
