Hypertension, pre-eclampsia and eclampsia Flashcards
How can pre-eclampsia cause death?
intracranial haemorrhage
Which blood pressure reading is treated as an emergency?
> 160 mmHg systolic
List three maternal complications of pre-eclampsia
intracranial haemorrhage placental abruption Renal failure pulmonary oedema acute respiratory arrest HELLP syndrome Eclampsia
What is the triad of features in HELLP syndrome
haemolysis
elevated liver enzymes
low platelets
List two fetal complications of pre-eclampsia
intrauterine growth restriction oligohydramnios hypoxia from placental insufficiency placental abruption premature delivery
What are the pharmacological options for management of moderate pre-eclampsia?
oral labetalol 150-160mmHg
What are the options for severe pre-eclampsia?
combination of
oral/IV labetalol
oral nifedipine
IV hydralazine
Which NEWS chart is used in pregnancy?
MOWES
modified/maternity obstetric early warning score
How should you manage fluid input in pre-eclampsia?
restriction
1ml/kg/hr OR 80 ml/hr
monitor hourly urine output
>400 ml/4 hr
What is the definition of eclampsia?
one or more convulsion associated with pre-eclampsia
What is the drug treatment for eclampsia?
magnesium sulphate
Can you use benzodiazepines in eclampsia?
No!!! avoid phenytoin and diazepam. Seizures are caused by different mechanism in eclampsia
Why should you perform U+Es when administering magnesium sulphate?
excreted by the kidneys therefore risk of toxicity, higher with oligouria and renal impairment
List two signs of magnesium sulphate toxicity
loss of deep tendon reflexes
respiratory depression
respiratory arrest
cardiac arrest
What is the indication for sytocinon?
=oxytocin. It belongs to a group of medicines called oxytocics that make the muscles of the womb contract. Syntocinon is used:
• to start or help contractions during labour • to help in the management of a miscarriage
• to prevent and control bleeding after delivery of your baby
• during a caesarean section.
Name two presentations which are pre-eclampsia until proven otherwise
headache
epigastric pain
What is the calculation for BP?
Systemic vascular resistance x CO
What is the equation for CO?
HR x SV
How do you distinguish between chronic hypertension, gestational hypertension, and pre-eclampsia?
chronic hypertension- <20 weeks
gestational hypertension->20 weeks and no proteinuria
pre-eclampsia- >20 weeks + proteinuria
What is the pathophysiology of pre-eclampsia?
development of abnormal placenta, involvement of spiral arteries. Fibrous spiral arteries, poorly perfursed placenta, leading to pro-inflammatory factors causing vascular endothelial dysfunction, vasoconstriction, platelet activation and intravascular coag, increased vascular permeability
Why does proteinuria occur?
limited blood flow damages glomeruli, damaging kidneys- proteinuria oligouria
Why does pulmonary oedema and peripheral oedema arise in pre-eclampsia?
increased vascular permeability
How is hypertension defined in pregnancy? (numbers)
140/90
List two complications of pre-eclampsia
eclampsia stroke renal failure liver failure HELLP DIC death c-section delivery
List two complications of pre-eclampsia for the fetus
intrauterine growth restriction
placental abruption
premature birth
perinatal death
What are the three methods for urine testing?
urinalysis +1
Urine PCR >30 mg/mmol
24 hr urine collection >300 mg/24 hr
WHat are the investigations for pre-eclampsia
urine testing
bloods
CTG
Umbilical artery doppler
Three risk factors for pre-eclampsia
autoimmune disease diabetes chronic HTN previous PIH nulliparity >40 years BMI >35 years family history mulitple pregnancy
Name one autoimmune disease that is a risk factor for pre-eclampsia?
antiphospholipid syndrome
Which drug is given as prophylaxis for pre-eclampsia
aspirin
What are the antihypertensive drugs used in pre-eclampsia
labetalol
nifedipine
methyldopa
What must be monitored in with magnesium sulphate treatment
respiratory rate and reflexes/tone
