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Obs & Gyn > Hypertensive disease in pregnancy > Flashcards

Hypertensive disease in pregnancy Flashcards

1
Q

how can chronic hyptension be classifed in pregnancy 2

A

presence of hypertension before 20 weeks in absence of hydatidiform mole
or
persistent hypertension beyond 6 weeks postpartum

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2
Q

2 types of hypertension in pregnancy

A

chronic hypertension

gestational hypertension

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3
Q

what can chronic hypertension in pregnacy be further subclassifed into 3

A

chronic hypertension - without proteinuria

chronic renal disease (proteinruia with or without hypertension)

chronic hypertension with superimpased pre-eclapmsia (new onset proteinuria)

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4
Q

define a hydatidiform mole

A

rare mass or growth that forms inside the womb (uterus) at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD

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5
Q

types of gestational hypertension 3

A

gestational hypertension- without proteinuria

gestational proteinuria- without hypertension

gestational proteinuric hypertenstion- pre-eclampsia

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6
Q

define pre-eclampsia

A

defined as hypertension developing after 20 weeks gestation with or more of:
-proteinuria
-maternal organ dysfunction
-fetal growth restriction

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7
Q

what is needed in conjuction with hypertension for a diagnosis of pre-ecampsia

A

one of:
-proteinuria
-maternal organ dysfuction
-fetal growth restriction

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8
Q

state some examples of maternal organ dysfunction that constitute part of a pre-eclampsia diagnosis 4

A

renal insufficeincy (creatinein >90micromol/l)

liver involement (elevated trasnaminases

neurological complications
-eclampsia, altered mental status, blindness, stroek
most commonly - hyperreflexia when accompanied by clonus, headache with hyperreflexia

haematological complications - thrombocytopenia, DIC, haemolysis

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9
Q

define eclampsia

A

generalised tonic-clonic convulsions in women with pre-eclampsia

if seziures cannot be attributed to any other cause (epilepsy, cerebral infarction, tumour, ruptured aneurysm)

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10
Q

state the two phases of eclampsia

A

phase 1- abnormal placentation

phase 2- endothelial dysfunction

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11
Q

what happens in phase 1 of eclampsi

A

inadequate torphoblatic invasion-> inadequate placental perfusion

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12
Q

what happens in phase 2 of eclampsia

A

widespread endothelial damaeg and dysfunction

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13
Q

risk factors for pre-ecmapsia 6

A

first pregnancy

FHx

exteremes of materal age

obesity

medical factors

obstetric factors

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14
Q

medical factors for pre-eclampsia 6

A

pre-exisiting hypertension

renal disease

diabetes

acquired thrombophilia (antiphospholipid Ab)

inherited thrombophilia

CT diseases - ie SLE

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15
Q

obstetric facotrs for pre-eclampsia 6

A

multiple pregnancy

previous preeclampsia

hydros fetalis

hydatidiform mole

triploidy

inter-pregnancy interval >10yrs

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16
Q

symptoms of pre-eclampsia 6

A

severe headache

severe right upper quadrant pain and/or epigastric pain

sudden swelling of hands, face or feet

visual distrubances- blurring, flashing, scotoma (blind spot in vision)

17
Q

signs of pre-eclampsia 8

A

hypertension and proteinuria

hyperreflxia

serum creatiine raised

platelet cound decreased

clonus

haemolytic anaemia

elevated liver enzymes

retinal haemorrhages and papilloedma

18
Q

clinical assessment of pre-eclapmsia 3

A

BP- use manual cuff of right size

Urinalysis- proteinuria
-abnormal if >40mL/dL or + on dipstick

blood tests
-AST and transaminitis -> hepatocellular damage

19
Q

what is a severe variant of pre-eclapmisa

A

HELLP
Haemolysis
Elevated Liver enzymes
Low Platelets

-screen for clotting disorder, can cause DIC

20
Q

Of the following investiagion what would be the findings in preeclampsia:
FBC 3

A

low platelets
Low Hb
haemolysis on blood film

21
Q

Of the following investiagion what would be the findings in preeclampsia:
Renal function 4

A

reduced urine output
increased urate
increased urea
increased creatinine

22
Q

Of the following investiagion what would be the findings in preeclampsia:
coagulation system 1

A

prolonged coagualations indices

23
Q

Of the following investiagion what would be the findings in preeclampsia:
hepatic system 2

A

elevated ALT
elevated AST

24
Q

what happens in the fetal assessment for a mother with pre-elampsia 2

A

symphysial fundal height assessed

US for fetal growth, liquor volume and umbiliccan artery doppler

if fetal compromise - delivery

25
Q

prevention of pre-elcampsia 1

A

aspirin- inhibts prostaldin synthesis

75mg of aspirin from 12 weeks gestation

26
Q

prinicples of manamegnt of pre-eclapmisa and eclampsia

A

control maternal blood pressue to <150/100

assess fluid balance

prevent seizures (eclapmsia)
-use magneisum suphate to half risk of eclapmsia

consider delivery

optomise post-natal care

27
Q

what are maternal indiatsion of the need to deliver baby if mum has pre-ecelpampsi 5

A

gestation>37wks

fialure to control hypertension

deterioiriating liver/renal function

progressive fall in platelets

neuro complications

28
Q

what are fetal indications for delviery in a mother with pre-eclampsia/eclampsia

A

abnormla fetal heart rate

deteriorating fetal condition

29
Q

drug treatment options for hypertension in prenfnacy 4

A

methyldopa- safe- slow onsset - not suitbale if history of depression

labetalol-widely used

hydralazine- used in hypertensive crisis

nifedipine- watch for preciptious fall in BP when used with MgSO4

30
Q

maternal complications of pre-eclampsia 10

A

placental rupture

DIC

HELLP

pulmonary oedema

aspiration

eclampsia

liver failure

stroke

death

long term cardiovasulc morbidity

31
Q

fetal complications of pre-eclampsia 5

A

pre-term delivery

IUGR

hypoxia-neurological injury

perinatal death

long term caridcascilar morbitidy

32
Q

future risk of hypertension from pre-eclampia mothers

A

if mother had gestation hypertenion or pre-eclampia

-icnresed risk of developing high blood pressure and its complications later in life

33
Q

normal physiological changes of blood pressure in pregnancy

A

decrease in both systolic and diastolic BP during pregnancy

34
Q

state the values atributed to both hypertension and severe hypertension in pregnancy 2

A

hypertension- BP of 140/90 - 159/109

severe hypertension - BP of 160/110 or more

Obs & Gyn (23 decks)

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