Hypertensive Disease In Pregnancy Flashcards
Overall Rate of preeclampsia
3-5%
Incidence of eclampsia
27.5 per 10000 maternities
Eclampsia rate in patients with preeclampsia
1%
Chronic hypertension with superimposed preeclampsia
25%
Risk of preeclampsia if mother had preeclampsia
20-25%
Risk of preeclampsia if sister has preeclampsia
35-40%
Risk of recurrent pregnancy induced hypertension
11-15%
PIH in current pregnancy..
Risk of preeclampsia in future ?
7%
Preeclampsia in current pregnancy…
Risk of PIH in future
13-53%
Risk of recurrent preeclampsia if delivery <34 weeks due to severe pe, hellp syndrome or eclampsia
25%
Risk if recurrent preeclampsia if delivery 34-37 weeks
23%
PIH developing CHTN
3%
Preeclampsia risk of :
Cardiovascular event
1.5-3 fold
Pre eclampsia risk of
Cardiovascular death
2 fold
Pre eclampsia risk of
Stroke
2-3 fold
Pre eclampsia risk of
Developing HTN
2-5 fold
PIH risk
Cardiovascular event
1.5-3 fold
PIH risk
Developing HTN
2-4 fold
High risk factors for developing pre eclampsia (5)
- CKD
- Preexisting Diabetes
- Chronic HTN
- Previous preeclampsia
- Autoimmune disease
Moderate risk factors of developing pre eclampsia (6)
- BMI >35kg/m2 (Fat)
- primigravida (First)
- Family history of preeclampsia (Family)
- interpregnancy interval >10 years (Far)
- 40 years old and above (Forty)
- multiple pregnancy (Fetus)
Indications for delivery (5)
- inability to control BP on 3 maxed out agents
- worsening biochemical markers: platelet <100, creatinine >90 umol/l, albumin <20g/l
- eclampsia, pulmonary edema, stroke
- symptoms of impending eclampsia
- fetal compromise: fetal distress, severe for, reversed umbilical artery diastolic flow
MOA : nifedipine
Calcium channel blocker
MOA: Labetolol
Alpha and beta adrenergic blocker
MOA: hydralazine
Direct smooth muscle relaxant resulting in vasodilation
MOA methyldopa
Alpha adrenergic agonist
- reduced total peripheral resistance
- decreased systemic blood pressure
MgSO4 therapeutic Range
2-4 mmol/l
MgSO4 toxicity level
3.5-5 mmol/l
Incidence HELLP Syndrome
0.5-0.9%
Risk of placental abruption with preexisting HTN
4%
HELLP syndrome recurrence
Developed <32 weeks
60%
HELLP Syndrome recurrence
Developed @>32 weeks
10%
Percentage of patients who present with eclampsia that have severe htn
40%
Recurrence rate of eclampsia
10%
Maternal mortality associated with eclampsia
0.4- 5.8%
Mortality rate of eclampsia
1:50
Findings if the ASPRE study
- reduction in delivery with pre eclampsia before 37 weeks with the use of asa 150mg from 4.3% to 1.6%
Percentage of patients with pre eclampsia who develop HELLP syndrome
5-20%
What percentage of patients develop HELLP postpartum
25%
Is HELLP always preceeded by hypertension and proteinuria?
No
1/3 patient would have neither
Mortality rate of HELLP
1% in resource rich countries
Perinatal mortality with HELLP
7-60%
Overall risk of hypertensive disorders in pregnancy
8-10%
Risk preeclampsia in subsequent pregnancy if eclampsia lead to birth <28weeks
55%
What are renal function test indicate AKI in pregnancy
-Serum Urea >17mmol/l requires renal replacement therapy
- creatinine >90umol/l
What percentage of patients with HELLP syndrome have AKI
3-15%
What percentage of patients with pre eclampsia develop AKI
Up to 2 %
What percentage of women with untreated APS develop GHTN/preeclampsia
30-50%
Decreases to 10% with treatment
