Hypertensive disease in pregnancy Flashcards
how can chronic hyptension be classifed in pregnancy 2
presence of hypertension before 20 weeks in absence of hydatidiform mole
or
persistent hypertension beyond 6 weeks postpartum
2 types of hypertension in pregnancy
chronic hypertension
gestational hypertension
what can chronic hypertension in pregnacy be further subclassifed into 3
chronic hypertension - without proteinuria
chronic renal disease (proteinruia with or without hypertension)
chronic hypertension with superimpased pre-eclapmsia (new onset proteinuria)
define a hydatidiform mole
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
types of gestational hypertension 3
gestational hypertension- without proteinuria
gestational proteinuria- without hypertension
gestational proteinuric hypertenstion- pre-eclampsia
define pre-eclampsia
defined as hypertension developing after 20 weeks gestation with or more of:
-proteinuria
-maternal organ dysfunction
-fetal growth restriction
what is needed in conjuction with hypertension for a diagnosis of pre-ecampsia
one of:
-proteinuria
-maternal organ dysfuction
-fetal growth restriction
state some examples of maternal organ dysfunction that constitute part of a pre-eclampsia diagnosis 4
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
define eclampsia
generalised tonic-clonic convulsions in women with pre-eclampsia
if seziures cannot be attributed to any other cause (epilepsy, cerebral infarction, tumour, ruptured aneurysm)
state the two phases of eclampsia
phase 1- abnormal placentation
phase 2- endothelial dysfunction
what happens in phase 1 of eclampsi
inadequate torphoblatic invasion-> inadequate placental perfusion
what happens in phase 2 of eclampsia
widespread endothelial damaeg and dysfunction
risk factors for pre-ecmapsia 6
first pregnancy
FHx
exteremes of materal age
obesity
medical factors
obstetric factors
medical factors for pre-eclampsia 6
pre-exisiting hypertension
renal disease
diabetes
acquired thrombophilia (antiphospholipid Ab)
inherited thrombophilia
CT diseases - ie SLE
obstetric facotrs for pre-eclampsia 6
multiple pregnancy
previous preeclampsia
hydros fetalis
hydatidiform mole
triploidy
inter-pregnancy interval >10yrs
symptoms of pre-eclampsia 6
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)
signs of pre-eclampsia 8
hypertension and proteinuria
hyperreflxia
serum creatiine raised
platelet cound decreased
clonus
haemolytic anaemia
elevated liver enzymes
retinal haemorrhages and papilloedma
clinical assessment of pre-eclapmsia 3
BP- use manual cuff of right size
Urinalysis- proteinuria
-abnormal if >40mL/dL or + on dipstick
blood tests
-AST and transaminitis -> hepatocellular damage
what is a severe variant of pre-eclapmisa
HELLP
Haemolysis
Elevated Liver enzymes
Low Platelets
-screen for clotting disorder, can cause DIC
Of the following investiagion what would be the findings in preeclampsia:
FBC 3
low platelets
Low Hb
haemolysis on blood film
Of the following investiagion what would be the findings in preeclampsia:
Renal function 4
reduced urine output
increased urate
increased urea
increased creatinine
Of the following investiagion what would be the findings in preeclampsia:
coagulation system 1
prolonged coagualations indices
Of the following investiagion what would be the findings in preeclampsia:
hepatic system 2
elevated ALT
elevated AST
what happens in the fetal assessment for a mother with pre-elampsia 2
symphysial fundal height assessed
US for fetal growth, liquor volume and umbiliccan artery doppler
if fetal compromise - delivery
