hypertension + pre eclampsia

Question 1

what occurs to BP during pregnancy?

Answer 1

BP gradually falls until week 24 (just before the end of 2nd trimester)

from week 24 BP steadily rises until delivery

Question 2

how can you tell the difference between pregnancy induced hypertension and pre existing hypertension?

Answer 2

pre existing hypertension BP >140/90mmHg before 20 weeks gestation

pregnancy induced hypertension BP>140/90 after 20 weeks gestation

Question 3

hypertension treatment if pregnant?

Answer 3

1st= labetalol
2nd (if asthmatic)= nifedipine
3rd= methyl dopa

Question 4

what is pre eclampsia?

Answer 4

pre eclampsia refers to new high BP in pregnancy, with end organ dysfunction, notably with proteinuria

Question 5

when does pre eclampsia often occur?

Answer 5

> 20 weeks

( BP in pregnant woman tends to decrease until about 24 weeks and then begins to increase from 24- delivery)

Question 6

pathophysiology of pre eclampsia?

Answer 6

the spiral arteries of the placenta form abnormally, leading to high vascular resistance in these vessels

Question 7

high risk of pre eclampsia?

Answer 7

-pre existing hypertension
-previous hypertension in pregnancy
-existing autoimmune conditions (SLE)
-diabetes
-CKD

Question 8

moderate risk of pre eclampsia?

Answer 8

> 40 years
BMI>35
-More than 10 years since previous pregnancy
-First pregnancy
-FH of pre eclampsia

Question 9

symptoms of pre eclampsia?

Answer 9

-Headache
-N+V
-Visual disturbances
-Upper abdominal or epigastric pain (due to liver swelling)
-Oedema
-Reduced UO
-Brisk reflexes

Question 10

Diagnosis of pre eclampsia?

Answer 10

Diagnosis can be made with:
Hypertension (>140 systolic, >90 diastolic)

Plus any of:
-Proteinuria
-Placental dysfunction (restricted foetal growth or abnormal doppler studies)
-End organ dysfunction (raised creatinine, elevated liver enzyme, seizures, thrombocytopaenia or haemolytic anaemia)

Question 11

what investigation can be done for pre eclampsia and when can it be done?

Answer 11

PIGF (placental growth factor)
-it can be measured between 20 and 35 weeks

Question 12

if someone has pre eclampsia, what will their PIGF measure be?

Answer 12

PIGF will be low in someone with pre eclampsia

(measured between 20 and 35 weeks)

Question 13

management of high risk patients for pre eclampsia?

Answer 13

High risk patients:
-CKD
-Diabetes
-Existing autoimmune disease (SLE)
-Hypertensive during previous pregnancy
-Pre existing hypertension

Give 150mg aspirin daily from 12 weeks- 36 weeks

Question 14

management of someone with more than 1 moderate risk for pre eclampsia?

Answer 14

More than one of :
-First pregnancy
-Smoker
-Obese (BMI >35) at first visit
->40 years
-10 years since previous pregnancy
-FH of pre eclampsia

Give 150mg aspirin daily from 12 weeks- birth

Question 15

management of pre eclampsia?

Answer 15

High risk= give 150mg aspirin daily from 12-36 weeks

> 1 moderate risk= give 150mg aspirin daily from 12 weeks- birth

1st= Labetalol
2nd/ asthmatic= Nifedipine
3rd= methyldopa (CI in depression)

planned early birth may be necessary if pre eclampsia cannot be controlled
-if <34 weeks may give steroids to protect fetus from RDS
-Magnesium sulphate given during labour and 24 hours after to prevent seizures

Question 16

what blood pressure should be aimed for in pre eclampsia managmenet?

Answer 16

aim for a BP <135/85

Question 17

what BP suggests a mother needs admitted to hospital?

Answer 17

BP of 160/110

Question 18

what is eclampsia?

Answer 18

seizures associated with pre eclampsia

Question 19

management of eclampsia?

Answer 19

Control BP:
- IV labetalol and IV hydralazine

Stop seizures:
- IV magnesium sulphate
if seizures persistent consider IV diazepam

if mother experiences respiratory depression= calcium gluconate

Question 20

role and MofA of magnesium sulphate?

Answer 20

Magnesium sulphate stops seizures, but also provides neuroprotection for the baby. This decreases the chance of hypoxic injury to the brain and potentially cerebral palsy.

MoA = Mg Sul. Inhibits NMDA receptors à limits the effect of glutamate (stimulatory neurotransmitter)
Magnesium blocks Ca2+ and K+ channels. Calcium is a direct antagonist to magnesium. So it binds to the magnesium receptors at the neuromuscular junction.

Question 21

what drug can be given if magnesium sulfate causes respiratory depression?

Answer 21

Calcium gluconate