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Obstetrics > Hypertensive disease > Flashcards

Hypertensive disease Flashcards

1
Q

What should be taken prophylactically from 12 weeks for people at risk of pre-eclampsia?

A

low dose aspirin (75mg OD)

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2
Q

For how long in pregnancy does the BP usually drop?

A

until ~20-24 weeks

Increases to pre-pregnancy BP till term

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3
Q

High risk groups for pre-eclampsia?

A 
Previous HTN disease of pregnancy
Chronic HTN (30% --> pre-eclampsia)
Chronic kidney disease
DM
Autoimmune e.g. SLE
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4
Q

Pregnancy induced HTN

A

After 20 weeks, 5-7% pregnancies
No oedema or proteinuria

Resolves after birth (usually ~1 month)

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5
Q

HELLP syndrome

A

Haemolysis (will also cause raised LDH)
Elevated Liver enzymes
Low Platelets

Key management:
IV magnesium sulphate to prevent seizures
IV dexamethasone
BP control - labetalol (can use methyl dopa/nifedipine)
Blood transfusions (as needed)

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6
Q

What problems does pre-eclampsia predispose to?

A

Foetus: prematurity, IUGR

Eclampsia
HELLP syndrome

Haemorrhage: Placental abruption, intra-abdominal, intracerebral

Cardiac / multi-organ failure

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7
Q

Risk factors for pre-eclampsia?

A

Age >40
BMI>30
Diabetes, obesity

PMH of pre-eclampsia (15% recurrence), HTN and/or renal disease
FH

Nulliparity/new partner (6% nulliparous women)
10 years since last pregnancy
Multi-pregnancy

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8
Q

Features of pre-eclampsia?

A

HTN (typically 170/110)
Proteinuria (later sign than BP rise)

Red flags:
Headache 
Visual disturbance and papilloedema
RUQ/epigastric pain
Oedema

Others:
N+V
Drowsiness

Hyperreflexia
Platelet count <100x10^6, abnormal liver enzymes

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9
Q

If treating HTN with methyl-dopa what should be done after birth?

A

Switch to ACE-i - risk of depression

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10
Q

Anti-HTN used in pregnancy

A

B-blockers - e.g. labetalol
Methyldopa
Nifedepine
Hydralazine

NB. NOT ACE-i = feto-toxic

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11
Q

Target BP in pregnancy induced HTN?

A

150/90

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12
Q

After birth when is BP highest?

A

3-4 days post-partum

Epigastric painm, visual disturbance, proteinuria = postpartum pre-eclampsia

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13
Q

Examination red flags in pre-eclampsia?

A

Peri-orbital oedema
Clonus >beats
Fits (eclampsia)
Hyper-refelxia

Others: confusion, placental abruption

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14
Q

Classification of pre-eclampsia?

A

Mild: 140-9/90-9
Moderate: 150-160/100-10
Severe: 160+/110+ or <34 weeks or maternal complications

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15
Q

Maternal complications of pre-eclampsia?

A 
Eclampsia
CVA
HELLP
DIC
Liver and renal failure
Pulmonary oedema
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16
Q

Foetal complications of pre-eclampsia?

A

IUGR
Pre-term birth
Placental abruption
Hypoxia

17
Q

Investigations

A

PCR = >30mg/l
or
24/hr collection = 0.3g

Monitor maternal complications:
Bloods: U+E, LFT, LDH, FBC, uric acid

Monitor foetal complications:
USS - weight
Umbilical artery doppler
CTG

18
Q

Management of pre-eclampsia?

A

Admit if symptomatic, proteinuria, BP>160/110

Drugs: Labetelol, nifedepine, methyl dopa (aim for 140/90) - improves maternal outcomes

Magnesium sulphate in severe disease

Steroids if <34 weeks

19
Q

Timing of delivery

A

If mild - before 37 weeks

Moderate-severe: delivery 34-37

If severe with complications then always urgently deliver

<34 weeks:
Conservative management and monitoring in specialist unit + steroids + weight up risk/benefit
CTG
Fluid balance and bloods

20
Q

Conduct of delivery

A

<34 weeks: CS
>34 weeks: induction with PGE2

Epidural helps decrease BP
Continuous CTG
BP and fluid balance
Antihypertensives
Maternal pushing should be avoided if BP >160/110 in second stage
Ocytocin>ergometrine
21
Q

Post-natal care

A

Can take 24hrs for severe disease to improve, treatment may be required for several weeks

Monitor bloods - liver enzymes, platelets, renal function

Fluid balance: catheter, caution of pulmonary oedema with fluids
If fluid balance is down –> CVP
Can give furosemide

22
Q

Eclampsia

A

1-2% of pre-eclampsia - most common after delivery

Tonic-clonic seizures

23
Q

Management of eclmapsia?

A

ABC - may need oxygen/intubation
Turn patient onto side

Magnesiun sulphate:

  • controls fits
  • IV loading dose 4g over 10 mins
  • then 1g/hr for 24 hrs
  • if further fits - give 2g bolus

Control HTN:

  • IV labetalol (avoid in asthmatics)
  • Oral nifedepine

CTG if antepartum
Deliver baby once stable

24
Q

HELLP syndrome

A

Haemolysis (microangiopathic)
Elevated liver enzymes
Low platelets

Symptoms:
RUQ/epigastric pain
N+V

Obstetrics (29 decks)

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