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Repro > Hypertension In Pregnancy (Pre-existing, PIH, Pre-eclampsia) > Flashcards

Hypertension In Pregnancy (Pre-existing, PIH, Pre-eclampsia) Flashcards

1
Q

Hypertension affects 10-15% of all pregnancies. T/F?

A

True

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2
Q

What is the commonest cause of iatrogenic prematurity?

A

Pre-eclamspia

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3
Q

Mild pre-eclampsia affects _ of primigravid women and severe pre-eclampsia affects _ of primigravid women.

A

10% mild,

1% severe

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4
Q 
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?
A 
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
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5
Q

Definition of hypertension in pregnancy? (2)

A

> 140/90 mmHg on 2 occasions or >160/110mmHg once

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6
Q

3 types of hypertension in pregnancy?

A

Pre-existing hypertension,
Pregnancy induced hypertension,
Pre-eclampsia

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7
Q

Pre-existing hypertension is usually diagnosed before pregnancy but may be a reprospective diagnosis if what?

A

If BP has not returned to normal within 3 months of delivery

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8
Q

List 5 secondary causes to consider in pre-existing hypertension?

A 
Renal, 
Cardiac, 
Cushing’s, 
Conn’s, 
Phaeochromocytoma
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9
Q

List 3 risks of pre-existing hypertension in pregnancy?

A

Pre-eclampsia risk increased x2,
FGR,
Placental abruption

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10
Q

Pregnancy induced hypertension is diagnosed when?

A

In second half of pregnancy

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11
Q

Rate of recurrence of PIH is high. However PIH resolves within how long of delivery?

A

6 weeks

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12
Q

PIH has better outcomes than pre-eclampsia but 15% of PIH progresses to what?

A

Pre-eclampsia

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13
Q

List 3 signs of pre-eclampsia? However?

A

Hypertension,
Proteinuria (uPCR > 30),
Oedema,
However - absence of any one of those does not exclude diagnosis!!

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14
Q

90% of cases of pre-eclampsia present when in pregnancy?

A

> /= 34 weeks AKA late pre-eclampsia so often not associated with placental disease

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15
Q

Pre-eclamspia classified by what pathophysiologically and affects what systems?

A

Vascular endothelial dysfunction causing widespread circulatory disturbance affecting renal, hepatic, cardiovascular, haematology, CNS or placenta

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16
Q

Pre-eclampsia has a genetic/environmental predisposition. What are the two stages of pre-eclasmpia in terms of pathogenesis?

A

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

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17
Q

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

A

High capacity, low resistance vessels which increases blood flow

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18
Q

What does the failure of cytotrophoblast/decidual interaction cause?

A

Oxidative stress and proinflammatory cytokines leads to imbalance with antiangiogenesis and angiogenesis factors

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19
Q

List 8 diff system outcomes of pre-eclampsia

A 
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
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20
Q

What is HELLP syndrome?

A

Haemolysis, Elevated Liver Enzymes, Low Platelets - has high morbidity for both baby and mom

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21
Q

What are 3 specific signs of HELLP syndrome?

A

Epigastric/RUQ pain,
Abnormal liver enzymes
Hepatic capsule rupture

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22
Q

5 common symptoms of pre-eclampsia?

A 
Headahce, 
Visual disturbance, 
Epigastric/RUQ, 
N&V, 
Rapidly progressive oedema
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23
Q

8 signs of pre-eclampsia?

A 
Hypertension, 
Proteinuria, 
Oedema, 
Abdo tenderness, 
Disorientation, 
Hyper-reflexia/involuntary movements/clonus, 
SGA fetus, 
Intra-uterine fetal death
24
Q

Many women with pre-eclampsia are asymptomatic at time of presentation. True/False?

25
Q

Investigations for pre-eclampsia? (8)

A 
U&Es, 
Serum urate, 
LFTs, 
FBC, 
Coagulation screen, 
uPCR, 
CTG, 
USS of foetus
26
Q

Prediction of pre-eclampsia can be seen when?

A

Maternal uterine artery doppler - uterine artery notching at 20-24weeks anomaly scan

27
Q

What is given to women at high risk of pre-eclampsia?

A

Aspirin 150mg commenced before 16 weeks

28
Q

List medical factors at high risk of pre-eclampsia (5)

A 
Renal disease,
HTx,  
DM, 
connective tissue disorders e.g. lupus, 
Thrombophilias (aPS)
29
Q

List 9 crises in pre-eclampsia?

A 
Eclampsia, 
HELLP syndrome, 
Pulmonary oedema, 
Placental abruption, 
Cerebral haemorrhage, 
Cortical blindness, 
DIC, 
Acute renal failure, 
Hepatic rupture
30
Q

What is eclampsia?

A

Tonic-clonic seizure (grand mal) occurring with features of pre-eclamspia

31
Q

Greater than 1/3 with eclamspia will have what before onset of hypertension/proteinuria?

A

Will have seizure

32
Q

Most eclampsia occurs during what two stages of pregnancy?

A

Post-partum and ante-partum

33
Q

Eclampsia is more common in what age group?

34
Q

How are women screened for pre-eclamspia in pregnancy?

A

Risk assessed at booking,
Antenatal screening - BP, urine, biochemical and USS,
Hypertension treated,
Close monitoring

35
Q

Risk factors for hypertension in pregnancy? (9)

A 
Maternal age >40yrs (x2), 
Maternal BMI >30 (x2), 
FH (20-25% if mother affected, up to 40% if sister), 
Parity first pregnancy, 
Multiple pregnancy, 
Previous PE (x7), 
Birth interval >10yrs, 
Molar pregnancy/triploidy, 
Multiparous women develop more severe disease
36
Q

How does aspirin work?

A

Inhibits cyclo-oxygenase which prevents TXA synthesis

37
Q

6 situations in which pregnant women should be admitted?

A

BP >170/110 OR >140/90 with ++proteinuria,
Symptoms e.g. headache/visual disturbance/abdo pain,
Abnormal biochem,
Significant proteinuria (uPCR >30),
Starting antihypertensive therapy,
Signs of foetal compromise

38
Q

Threshold for treatment of hypertension in pregnancy for PIH, pre-existing or pre-eclampsia? What is aim for BP?

A

Most treat if BP persistently >150/100mmHg and aim for 140-150/90-100mmHg,
Need immediate treatment if BP >170/110mmHg

39
Q

If MAP >150mmHg in pregnancy there is a significant risk of what?

A

Cerebral haemorrhage

40
Q

Treatment and control of BP reduces risk of developing pre-eclampsia. T/F?

A

False - it does not reduce risk it just reduces risk of complications

41
Q

First line drugs for treatment of HTx in pregnancy? (Name, mechanism of action, contraindication, can it be used in pregnancy?

A

Methyldopa - alpha agonist - depression - yes,
Labetolol - alpha & beta agonist - asthma - yes,
Nifedipine - CCB - yes

42
Q

Second line for treatment of hypertension? (Drug name,mechanism of action, and can it be used in breast feeding)

A

Hydralazine - vasodilator - yes,

Doxazocin - alpha antagonist - no in breastfeeding

43
Q

Tend to start with one drug and work up to max dose before trying another drug unless experiencing side effects for treatment of hypertension. T/F?

44
Q

Avoid what two drugs for hypertension in pregnancy?

A

Diuretics and ACEi

45
Q

Fetal surveillance is carried out in 3rd trimester of pregnancy in pre-eclampsia. How are they assessed?

A

fetal movements,
CTG,
USS - foetal growth, amniotic fluid, umbilical artery doppler

46
Q

Why does oligohydramnios occur in sick babies?

A

Sick baby will divert blood away from kidneys to vital organs brain and heart and so less amniotic fluid

47
Q

How will placental dysfunction appear on umbilical artery doppler? (2)

A

Absent end diastolic flow or reversed end diastolic flow

48
Q

What is the only cure for pre-eclampsia?

A

Birth but need to stabilise mother BP

49
Q

What is given to baby/women at risk of preterm delivery (prior 32 weeks)

A

Steroids to baby for lungs and magnesium sulphate to improve neuro outcomes for babies

50
Q

Most women diagnosed with pre-eclampsia will deliver within how many weeks of diagnosis?

51
Q

List indications for birth in pre-eclampsia? (5)

A 
Term gestation, 
Inability to control BP, 
Rapidly deteriorating biochem/haematology, 
Eclampsia, 
Fetal compromise
52
Q

Management of severe PET/eclampsia? (4)

A

Control BP,
Stop/prevent seizures,
Fluid balance,
Delivery

53
Q

Antihypertensives for severe PET/pre-eclampsia?

A

IV labetolol,

IV hydralazine

54
Q

Seizure treatment/prophylaxis for severe PET/pre-eclampsia?

A

Magnesium sulphate - 4g IV over 5mins then maintenance dose IV infusion 1g/h for 24hrs,
If persistent seizures then consider diazepam 10mg IV

55
Q

Main cause of maternal death in pre-eclampsia and how does this affect treatment?

A

Pulmonary oedema so safer to run a patient “dry”

56
Q

Labour and birth management principles in pre-eclampsia? (6)

A 
Vaginal birth if possible, 
Control BP< 
Epidural anaesthesia, 
Continuous electronic fetal monitoring, 
Avoid ergometrine, 
Caution with IV
57
Q

Post-partum management for all women with hypertension?

A

Encourage breast-feeding,
Consider contraception,
BP management,
Consider future risk incl. long term CVS risk

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