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1 Obs & Gyn > Hypertension, pre-eclampsia and eclampsia > Flashcards

Hypertension, pre-eclampsia and eclampsia Flashcards

1
Q

How can pre-eclampsia cause death?

A

intracranial haemorrhage

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2
Q

Which blood pressure reading is treated as an emergency?

A

> 160 mmHg systolic

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3
Q

List three maternal complications of pre-eclampsia

A 
intracranial haemorrhage
placental abruption 
Renal failure
pulmonary oedema
acute respiratory arrest
HELLP syndrome
Eclampsia
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4
Q

What is the triad of features in HELLP syndrome

A

haemolysis
elevated liver enzymes
low platelets

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5
Q

List two fetal complications of pre-eclampsia

A 
intrauterine growth restriction 
oligohydramnios
hypoxia from placental insufficiency 
placental abruption
premature delivery
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6
Q

What are the pharmacological options for management of moderate pre-eclampsia?

A

oral labetalol 150-160mmHg

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7
Q

What are the options for severe pre-eclampsia?

A

combination of
oral/IV labetalol
oral nifedipine
IV hydralazine

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8
Q

Which NEWS chart is used in pregnancy?

A

MOWES

modified/maternity obstetric early warning score

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9
Q

How should you manage fluid input in pre-eclampsia?

A

restriction
1ml/kg/hr OR 80 ml/hr

monitor hourly urine output
>400 ml/4 hr

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10
Q

What is the definition of eclampsia?

A

one or more convulsion associated with pre-eclampsia

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11
Q

What is the drug treatment for eclampsia?

A

magnesium sulphate

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12
Q

Can you use benzodiazepines in eclampsia?

A

No!!! avoid phenytoin and diazepam. Seizures are caused by different mechanism in eclampsia

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13
Q

Why should you perform U+Es when administering magnesium sulphate?

A

excreted by the kidneys therefore risk of toxicity, higher with oligouria and renal impairment

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14
Q

List two signs of magnesium sulphate toxicity

A

loss of deep tendon reflexes
respiratory depression
respiratory arrest
cardiac arrest

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15
Q

What is the indication for sytocinon?

A

=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.

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16
Q

Name two presentations which are pre-eclampsia until proven otherwise

A

headache

epigastric pain

17
Q

What is the calculation for BP?

A

Systemic vascular resistance x CO

18
Q

What is the equation for CO?

A

HR x SV

19
Q

How do you distinguish between chronic hypertension, gestational hypertension, and pre-eclampsia?

A

chronic hypertension- <20 weeks
gestational hypertension->20 weeks and no proteinuria
pre-eclampsia- >20 weeks + proteinuria

20
Q

What is the pathophysiology of pre-eclampsia?

A

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

21
Q

Why does proteinuria occur?

A

limited blood flow damages glomeruli, damaging kidneys- proteinuria oligouria

22
Q

Why does pulmonary oedema and peripheral oedema arise in pre-eclampsia?

A

increased vascular permeability

23
Q

How is hypertension defined in pregnancy? (numbers)

A

140/90

24
Q

List two complications of pre-eclampsia

A 
eclampsia
stroke
renal failure
liver failure
HELLP
DIC
death
c-section delivery
25
Q

List two complications of pre-eclampsia for the fetus

A

intrauterine growth restriction
placental abruption
premature birth
perinatal death

26
Q

What are the three methods for urine testing?

A

urinalysis +1
Urine PCR >30 mg/mmol
24 hr urine collection >300 mg/24 hr

27
Q

WHat are the investigations for pre-eclampsia

A

urine testing
bloods
CTG
Umbilical artery doppler

28
Q

Three risk factors for pre-eclampsia

A 
autoimmune disease
diabetes
chronic HTN
previous PIH
nulliparity
>40 years
BMI >35 years
family history mulitple pregnancy
29
Q

Name one autoimmune disease that is a risk factor for pre-eclampsia?

A

antiphospholipid syndrome

30
Q

Which drug is given as prophylaxis for pre-eclampsia

A

aspirin

31
Q

What are the antihypertensive drugs used in pre-eclampsia

A

labetalol
nifedipine
methyldopa

32
Q

What must be monitored in with magnesium sulphate treatment

A

respiratory rate and reflexes/tone

1 Obs & Gyn (31 decks)

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