Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Obstetrics and gynaecology > Hypertensive conditions - Essential HTN, Pre-eclampsia and eclampsia > Flashcards

Hypertensive conditions - Essential HTN, Pre-eclampsia and eclampsia Flashcards

(50 cards)

Start Studying
1
Q

Describe the normal BP physiological changes in pregnancy

A

BP initially falls
Stabilises in 2nd trimester - usually 15mmHg lower than pre-pregnancy
Rises in third trimester
Reaches pre-pregnancy levels at term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define pre-eclampsia

A

New hypertension presenting after 20 weeks (on more than 2 occasions >4hrs apart) AND significant proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What percentage of pregnancies are complicated by hypertension?

A

10-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percentage of pregnancies are complicated by pre-eclampsia?

A

3-5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How many UK pregnancies are complicated by eclampsia?

A

1 in 3000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe what happens in pre-eclampsia

A

Abnormal trophoblast invasion and differentiation in the 1st trimester

Failure of trophoblast cells to destroy the muscularis layer of the spiral arteries - Underdeveloped spiral arteries

Failure to transform into low resistance vessels

Reduction of blood flow to the intervillous space

Uteroplacental ischaemia - poorly perfused placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What happens as a result of the defective placenta?

A

Toxic factors release
Influence of ischaemia leads to endothelial damage, redistribution of fluid, protein leakage through kidneys, vasoconstriction, activation of the coagulation system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List some risk factors for pre-eclampsia

A 
Obesity
Age >40 
Genetic predisposition - sister greater risk than mother 
Multiple pregnancy 
Primip 
Long birth interval 
Hydrops with large placenta
Hydatidiform mole
Triploidy 
Pre-existing HTN
CKD
DM
Antiphospholipid antibodies
Connective tissue disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List some clinical features of pre-eclampsia

A 
HTN
Proteinuria
Oedema
Headaches
Visual disturbances
Epigastric pain 
Clonus
Rib pain 
Vomiting
IUGR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some complications of pre-eclampsia

A

Maternal:

  • Eclampsia (seizures)
  • Cerebral haemorrhage
  • Pulmonary oedema
  • Pulmonary embolism
  • Renal failure (AKI)
  • HELLP syndrome, liver haemorrhage and rupture
  • Disseminated intravascular coagulopathy

Foetal:

  • Placental abruption
  • Oligohydramnios
  • Foetal growth restriction
  • Increased risk of HTN
  • Increased risk of stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What clinical picture is seen in HELLP syndrome

A

Haemolysis
Elevated liver enzymes
Low platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is eclampsia

A

One or more tonic clonic seizure in association with features of pre-eclampsia and not attributable to any other cerebral pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What percentage of woman with eclampsia have symptoms of pre-eclampsia?

A

1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the management of pre-eclampsia

A

Monitoring
VTE prevention - LMWH
Antihypertensive - labetalol
Delivery , nifedipine, methyldopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe post natal care of pre-eclampsia

A

Usually resolves following delivery of placenta, however monitor mother for at least 24hrs post partum

Blood pressure monitored daily for first 2 days and then at least once 3-5day post partum and the need for antihypertensive should be assessed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What class of drug is labetalol?

A

Beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List the side effects of labetalol

A 
Postural hypotension
Fatigue
Headache
Nausea
Vomiting
Epigastric pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What class of drug is nifedipine?

A

Calcium channel blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List the side effects of nifidipine

A 
Peripheral oedema
Dizziness
Flushing
Headache
Constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What drug class is methyldopa

A

Alpha agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List the side effects of methyldopa

Study These Flashcards
A 
Drowsiness
Headache
Oedema
GI disturbance
Dry mouth 
Postural hypotension 
Bradycardia
Hepatotoxicity
22
Q

Which drug group of antihypertensive are contraindicated in pregnancy and why?

Study These Flashcards
A

ACE inhibitors

Association of congenital abnormalities

23
Q

What investigations should be done in pre-eclampsia

Study These Flashcards
A 
BP monitoring
Urine dipstick 
24hr urinary collection 
FBC - decreased Hb and platelets 
U&Es - increased urea, creatinine, urate and decreased urine output
LFTs - increased ALT and AST
24
Q

Which investigations should be done in eclampsia

Study These Flashcards
A 
FBC
U&Es
LFTs
Clotting studies
Blood glucose 
Neurological examination - clonus
25
Describe the immediate management of eclampsia
ABCDE assessment Left lateral position Secure airway and high flow O2 in non-rebreathe mask 2 large bore cannula BP monitoring Magnesium sulphate to stop seizures and also maintenance after as prophylaxis (4g in 100ml0.9% NaCl) Control BP - labetalol and hydralazine (target MAP of <120mmHg) Continuous CTG monitoring Prompt delivery of baby and placenta if needed - caesearean section/vaginal delivery Monitoring - fluid balance, BP
26
Describe the inpatient management of eclampsia
Regular symptoms review - headaches and epigastric pain Bloods 72hr post partum - FBC, LFT, creatinine Pre-conceptual counselling Step down care to community when BP target reached and asymptomatic
27
Describe the community care after eclampsia
CT head if neurology BP checked daily for 2 weeks post partum Follow up at 6 weeks - BP, proteinuria, creatinine, FBC, FSTs and creatinine
28
What is hypertension
>140/90 on two separate occasions
29
What is considered significant proteinuria?
Urine protein: creatinine ratio >30 | 24hr urinary protein >300mg
30
What is a hypertensive woman <20 weeks gestation considered to have and why?
Pre-existing/essential hypertension as BP usually falls in first trimester
31
Above what mean arterial pressure is maternal and foetal morbidity and mortality increased?
90
32
List some risks related to pre-existing/essential hypertension in pregnancy
``` Superimposed pre-eclampsia Placental abruption Foetal growth restriction Intracerebral haemorrhage Maternal cardiac failure Intracranial haemorrhage Maternal death ```
33
Describe pregnancy induced hypertension
BP >140/90 on two separate occasions >20/40 gestation No significant proteinuria
34
What are the different severities of pre-eclampsia?
Mild - BP 140/90 - 150/100 Moderate - BP 150/100 - 160/110 Severe - BP >160/110 or BP<160/110 but >2 signs/symptoms of severe pre-eclampsia
35
Describe the blood tests in pre-eclampsia and possible results
``` FBC - decreased Hb and platelets - <100 U&Es - creatinine >100 Uric acid - raised LFT - ALT>50 Clotting ```
36
Does the presence of hypertension and proteinuria always signify pre-eclampsia?
No - could be essential hypertension or renal disease - consider the gestation and onset
37
Is the presence of oedema a useful diagnostic sign?
No as can be normal in normal pregnancy | More specific if facial oedema however
38
Describe what happens to the liver in pre-eclampsia
Vasoconstriction in hepatic bed Periportal fibrin deposits, haemorrhage and hepatocellular necrosis Elevated liver enzymes Rarely - hepatic infarction and rupture of liver capsule
39
Describe what happens to the brain in pre-eclampsia
``` Cerebral vasoconstriction Oedema Membrane destabalisation Focal ischaemia Seizures Haemorrhage ```
40
When can seizures from eclampsia occur
Antenatally - 38% Intrapartum - 18% Postnatally - 44% usually within the first 24-48hrs post partum
41
What is HELLP syndrome associated with?
``` Eclampsia DIC Placental abruption Acute renal failure Pulmonary oedema ```
42
What percentage of women with HELLP syndrome will require a blood transfusion or blood products?
50%
43
What is used to prevent pre-eclampsia?
150mg aspirin daily from 12 weeks in moderate-high risk women
44
How is pre-eclampsia screened for in high risk women?
1st and 2nd trimester uterine artery dopplers Placental growth factor 1st trimester PAPP-A levels
45
What is PAPP-A
Pregnancy associated plasma protein | Produced by placenta
46
Describe recommended delivery in women with pre-eclampsia
C/S if <34 weeks MgSO4 if <32 weeks for foetal neuroprotection Vaginal delivery if >34 weeks, aim for short second stage and IV oxytocin for the 3rd stage
47
Which drugs should be avoided in the 3rd stage of labour with pre-eclampsia and why?
Ergometrine or synometrine - increases BP
48
What is the most important/most specific sign of pre-eclampsia to be elicited
Brisk tendon reflexes/clonus
49
Which drug is given to reverse the respiratory depressive effect of too much magnesium sulphate in eclampsia?
Calcium gluconate
50
How long should magnesium sulphate be continued postpartum?
24 hrs after delivery or after last seizure

Obstetrics and gynaecology (67 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions