Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

HDP- Hypertensive Diseases in Pregnancy > HYPERTENSIVE DISEASES OF PREGNANCY > Flashcards

HYPERTENSIVE DISEASES OF PREGNANCY Flashcards

1
Q

What are the risk factors of HDP according to ISSHP?

A

CAMP MAP

  • chronic HT
  • anti-phospholipid syndrome(SLE)
  • Multiple pregnancy
  • Prior pre-eclampsia
  • maternal BMI > 35
  • Assisted reproduction
  • pre-gestational DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the importance of HDP?

A
  • Leading cause of maternal mortality(MM) globally and 2nd leading in SA(18%)
  • eclampsia and pre-eclampsia are the leading HDP that cause death
  • since pre-eclampsia affects the endothelium, it is a multi-organ disease
  • 60% of HDP deaths due to substandard care
  • 75% of these are preventable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What’s the standard protocol of measuring BP?

A
  1. use a sphygmomanometer that’s indicated for pregnant women
  2. Woman must be in sitting position, legs uncrossed, relaxed, arm free of clothes at the level of the heart
  3. Hypertension>= 140/90mmHg. This should be checked again in 15 minutes if there are slight elevations in BP between 140-150mmHg
  4. Assess for obesity-BMI>=33 or MUAC >=35
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What’s borderline BP/ pre-HT in low risk pregnant women and how is it dealt with and managed?

A

When systolic BP is 135-139 and diastolic BP is 85-99.

  • BP must be repeated within 30mins to 2hrs.
  • If still in this range, send home and call after 7 days.
  • If lower, pt is low risk and if still between range, pt has pre-HT

Administer 500mg Ca supplements daily for all pregnant woman at any gestational age to reduce pre-eclampsia

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

How is proteinuria detected and why is this important?

A
  • visual dipstix
  • protein:creatinine ratio>0.3 = proteinuria
  • 24hr urine>300mg = proteinuria

NB to detect proteinuria as it may indicate pre-eclampsia

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

When, why and how much aspirin should be given to pregnant women?

A
  • Started from 12-14 weeks and up to 20 weeks
  • should be given to prevent pre-eclampsia
  • 75-162mg/day aspirin(quarter to half) given daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How should we examine and take history of a pregnant woman?

A
  • Big 5- CVS, renal, hepatic, GIT, neurological
  • Forgotten 4- haematology, endocrine, dermatological, musculoskeletal
  • core one- genitourinary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name the basic HDP tests

A
  • urine-msc, protein:creatinine, 24hr urine test
  • blood-FBC for Hb and platelets, creatinine, ALT & LDH
  • sonar once mom is stable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is HDP classified?

A

Chronic HT- before pregnancy and before 20 weeks gestation

White coat HT- HT at hospital but normal at home

Maternal HT- occurs after 20 weeks gestation

Pre-eclampsia- HT +/- proteinuria or organ dysfunction after 20 weeks of gestation.

HELLP syndrome- Hemolysis, Elevated Liver enzymes, Low Platelets

Eclampsia- more severe than pre-eclampsia and includes coma and seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the importance of HDP?

A
  • Leading cause of maternal mortality(MM) globally and 2nd leading in SA(18%)
  • eclampsia and pre-eclampsia are the leading HDP that cause death
  • since pre-eclampsia affects the endothelium, it is a multi-organ disease
  • 60% of HDP deaths due to substandard care
  • 75% of these are preventable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is HDP classified?

A

Chronic HT- before pregnancy and before 20 weeks gestation

White coat HT- HT at hospital but normal at home

Maternal HT- occurs after 20 weeks gestation

Pre-eclampsia- HT +/- proteinuria or organ dysfunction after 20 weeks of gestation.

HELLP syndrome- Hemolysis, Elevated Liver enzymes, Low Platelets

Eclampsia- more severe than pre-eclampsia and includes coma and seizures

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

Name the basic HDP tests

A
  • urine-msc, protein:creatinine, 24hr urine test
  • blood-FBC for Hb and platelets, creatinine, ALT & LDH
  • sonar once mom is stable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How should we examine and take history of a pregnant woman?

A
  • Big 5- CVS, renal, hepatic, GIT, neurological
  • Forgotten 4- haematology, endocrine, dermatological, musculoskeletal
  • core one- genitourinary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When, why and how much aspirin should be given to pregnant women?

A
  • Started from 12-14 weeks and up to 20 weeks
  • should be given to prevent pre-eclampsia
  • 75-162mg/day aspirin(quarter to half) given daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is proteinuria detected and why is this important?

A
  • visual dipstix
  • protein:creatinine ratio>0.3 = proteinuria
  • 24hr urine>300mg = proteinuria

NB to detect proteinuria as it may indicate pre-eclampsia

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

What’s borderline BP/ pre-HT in low risk pregnant women and how is it dealt with and managed?

A

When systolic BP is 135-139 and diastolic BP is 85-89

  • BP must be repeated within 30mins to 2hrs.
  • If still in this range, send home and call after 7 days.
  • If lower, pt is low risk and if still between range, pt has pre-HT

Administer 500mg Ca supplements daily for all pregnant woman at any gestational age to reduce pre-eclampsia

17
Q

What’s the standard protocol of measuring BP?

A
  1. use a sphygmomanometer that’s indicated for pregnant women
  2. Woman must be in sitting position, legs uncrossed, relaxed, arm free of clothes at the level of the heart
  3. Hypertension>= 140/90mmHg. This should be checked again in 15 minutes if there are slight elevations in BP between 140-150mmHg
  4. Assess for obesity-BMI>=33 or MUAC >=35
18
Q

How is HDP classified?

A

Chronic HT- before pregnancy and before 20 weeks gestation

White coat HT- HT at hospital but normal at home

Maternal HT- occurs after 20 weeks gestation

Pre-eclampsia- HT +/- proteinuria or organ dysfunction after 20 weeks of gestation.

HELLP syndrome- Hemolysis, Elevated Liver enzymes, Low Platelets

Eclampsia- more severe than pre-eclampsia and includes coma and seizures

19
Q

Name the basic HDP tests

A
  • urine-msc, protein:creatinine, 24hr urine test
  • blood-FBC for Hb and platelets, creatinine, ALT & LDH
  • sonar once mom is stable
20
Q

How should we examine and take history of a pregnant woman?

A
  • Big 5- CVS, renal, hepatic, GIT, neurological
  • Forgotten 4- haematology, endocrine, dermatological, musculoskeletal
  • core one- genitourinary
21
Q

When, why and how much aspirin should be given to pregnant women?

A
  • Started from 12-14 weeks and up to 20 weeks
  • should be given to prevent pre-eclampsia
  • 75-162mg/day aspirin(quarter to half) given daily
22
Q

How is proteinuria detected and why is this important?

A
  • visual dipstix
  • protein:creatinine ratio>0.3 = proteinuria
  • 24hr urine>300mg = proteinuria

NB to detect proteinuria as it may indicate pre-eclampsia

23
Q

What’s borderline BP/ pre-HT in low risk pregnant women and how is it dealt with and managed?

A

When systolic BP is 135-139 and diastolic BP is 85-99.

  • BP must be repeated within 30mins to 2hrs.
  • If still in this range, send home and call after 7 days.
  • If lower, pt is low risk and if still between range, pt has pre-HT

Administer 500mg Ca supplements daily for all pregnant woman at any gestational age to reduce pre-eclampsia

24
Q

What’s the standard protocol of measuring BP?

A
  1. use a sphygmomanometer that’s indicated for pregnant women
  2. Woman must be in sitting position, legs uncrossed, relaxed, arm free of clothes at the level of the heart
  3. Hypertension>= 140/90mmHg. This should be checked again in 15 minutes if there are slight elevations in BP between 140-150mmHg
  4. Assess for obesity-BMI>=33 or MUAC >=35
25
Q

What is the importance of HDP?

A
  • Leading cause of maternal mortality(MM) globally and 2nd leading in SA(18%)
  • eclampsia and pre-eclampsia are the leading HDP that cause death
  • since pre-eclampsia affects the endothelium, it is a multi-organ disease
  • 60% of HDP deaths due to substandard care
  • 75% of these are preventable
26
Q

Which features suggest pre-eclampsia?

A
  • HT<32 weeks gestation
  • IUGR
  • isolated proteinuria
  • HT and proteinuria
27
Q

What are steroids used for after 34 weeks gestation

A

Stimulate feral lung maturity when pre-eclampsia with severe features is indictated.

28
Q

What are the steps to stabilise a woman?

A
  • call for help
  • ABC
  • IV saline(restore fluids and electrolytes) and ringers lactate( restore circulating blood volume in burn and trauma victims)
  • MgSO4 to prevent seizures
  • BP reduction using 10mg oral nifedipine (every 30 minutes if BP doesn’t drop below 160/110)
  • administer oral a-methyldopa
  • check if fetus is alive and only monitor(sonar) once mom is stable and she will deliver at a DH
  • insert urinary catheter and monitor every hour for urine output until transferred
  • monitor vitals every 15 mins until transferred
  • during transfer mom accompanied by nurse and SBAR( situation, background, assessment, recommendation) form
  • mom must be monitored in the lateral position
29
Q

What is the immediate assessment during initial stabilisation

A
  • shake and shout
  • ABC
  • Lateral position
  • IV
  • MgSo4
  • Examine: big 5, forgotten 4, core 1
30
Q

How is Magnesium sulphate administered?

A
  • loading(14g)
  • 4g in 200ml normal saline IV over 20 mins
  • 5g in 1ml 2% lignocaine(local anaesthetic and anti-arrhythmic drug) IM in each butt

*maintenance
-5g in 1ml lignocaine IM every 4 hours (until 24hrs after birth or 24hrs after last convulsion)
-1g in 2ml in solution( MgSo4 always 50% solution)
!!!assess urine output, RR and reflexes before re-administration.
!!! If convulsions adminster 2g IV over 10-15 mins

31
Q

When should the next dose of magnesium not be administered?

A
  • Absent knee jerk
  • Urine output< 100mls in last 4 hours
  • Respiratory rate < 16BPM( administer calcium gluconate 10% 1g IV over 10 minutes)
32
Q

What are the indications of MgSO4?

A
  • Pre-eclampsia with severe features
  • imminent eclampsia
  • eclampsia
  • uncontrolled BPs
  • concern with transferring
33
Q

How is BP> 160/110 managed?

A

1ST LINE - 10mg oral nifedipine repeated every 30 minutes(max 4 times) or until BP<160/110

  • Contra- indications
  • pulse>120
  • cardiac lesion
  • unable to swallow

2ND LINE- labetolol(from 20 to 300mg) every 10 mins until BP< 160/110

  • Contra-indications
  • asthma
  • IHD
34
Q

How is fluid managed?

A
  • catheter and monitor input and output
  • IV 200ml NaCl or 80ml/hr RL (loading dose)
  • if output<25ml/hr give 200ml RL once
35
Q

When is delivery indicated for a mom with pre-eclampsia?

A

MATERNAL COMPLICATIONS at term or preterm: (CHOP CRUE)- recommend termination

  • CVA
  • HELLP
  • Organ dysfunction
  • Pulmonary oedema
  • Renal dysfunction (crest>120)
  • Uncontrolled BP
  • coagulaopathy (platelets<100 twice)
  • Eclampsia

28-33 WEEKS

  • first give corticosteroids
  • if unstable or with severe features, deliver after 48hrs if mom STABLE( no eclampsia, HELLP, or severe features ;normal bloods; controlled BP)
  • if stable and GA < 34 weeks , council and inform of expected care at the hospitals

> =34 weeks

  • inform mom of risks
  • neurological impairment
  • immature lungs and RDS
  • SIDS
  • NEC
  • ROP
36
Q

Discuss the induction of labour in hypertension

A
  • with eclampsia
  • urgent( 6hrs to get to labour. Delivery 12 hrs after induction)
  • favourable cervix
  • high care monitoring available
  • skilled doctors
  • without eclampsia
  • induce labour even if cervix is not favourable
37
Q

What is the proper post-op care in pre-eclampsia?

A
  • monitor chart
  • VTE
  • don’t discharge before 24hrs and administer MgSO4 for 24hrs
  • if eclampsia and organ dysfunction, keep in hospital for at least 3 days
  • stop antiHT (CCB and/or diuretics after 48hrs; ACEi and diuretics postpartum) gradually
  • provide contraception
  • counsel before discharge
38
Q

List post partum anti-HTs?

A

ACEi
-oral enalopril 5mg to 20mg/day

CCB
-amlodipine 5mg to 10mg/day

BB
-atenolol 50mg to 100mg/day

39
Q

List the warning signs of imminent eclampsia

A
  • SP>160mmHg more than 2 times, 6 hours apart
  • proteinuria
  • oliguria
  • cerebral/visual disturbances
  • pulmonary oedema or cyanosis
  • epigastric, chest pain
  • liver dysfunction
  • thrombocytopenia and other coagulopathy

HDP- Hypertensive Diseases in Pregnancy (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions