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Gyncology > Hypertensive Disorder in pregnancy _ ساجده الربيعي > Flashcards

Hypertensive Disorder in pregnancy _ ساجده الربيعي Flashcards

1
Q

what’re the hypertensive disorders in pregnancy ?

A 
1- chronic hypertension 
2- Gestationl hypertension
3- preeclampsia 
4- eclampsia 
5- Heelp syndrom
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2
Q

whats the chronic hypertension ?

A

increase in the blood pressure about (140/90)
Before 20 week of gestation

or it persistent hypertension 12 week after the delivery

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3
Q

what’s the gestational hypertension ?

A

when the blood pressure increase (more or equal 140/90) after 20 week without proteinuria and the BP will return to normal after 12 weeks of delivery

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4
Q

pt with Gestational hypertension can develop preeclampsia ?

A

yes , half of pt with gestational HT develop preclampsia

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5
Q

what’s the superimposed preeclampsia ?

A

when the pt have chronic HT and develop preeclampsia
(preeclampsia means have high BP with proteinuria after 20 weeks )

BP is 140/80 which is mild or 160/100 is sever before 20 week

Proteinuria more or equal 300mg/24 h after 20 week

+ with some decrease amount in the pallet because of the destruction less than 100,000/cmm

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6
Q

what’s the definition of the preeclampsia ?

A

(high BP(140/90) with proteinuria (>=300) after 20 week with or without edema )

but everything should return to normal after 12 week of delivery

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7
Q

what’s the eclampsia ?

A

preeclampsia signs
(high BP + proteinuria after 20 weeks )with coma and seizure during the pregnancy or postpartum
but the pt shouldn’t have any previous neurological disorders

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8
Q

what’re the risk factor of the preeclampsia ?

A 
maternal cause 
--------------------------
1- happen in nulliparity 
2- advance age 
3- obesity BMI >35 double the risk 
4-hypertension
5-diabetes 
6-thrombovascular disease

7- previous history of the preeclampsia
8- family history of preeclampsia
9- history of placental abroption ,IUGR, fetal death
10- non hispanic black raceالعرق الاسود غير اللاتيني

11- father may be cause of this by limit exposure of the paternal sperm

12- when the HCG is high in molar pregnancy and twins

13- smoking prevent from the preeclampsia

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9
Q

what’s the theory for the preeclampsia ?

A

its unknown mechanism
normal there will be trophoblast invasion that lead to vasodilation more nutrient to the baby
but if failure of the trophoblast invasion and lead to release of inflammatory mediatory by
decrease the PGI2 and increase the TXA2 which lead to vasoconstriction ,platelet aggregation , increase the vasopressor response(is a physiological nervous system response to increased intracranial pressure (ICP) ) & increase the uterine activity

1- abonormal placentation

2- inflammatory mediators as high TXA2 and low PGI2

3-Genetic
from family history by mutation in the complement
regulatory protein gene

4- Immunological
-as exposure of sperm from different partner
but when expose to paternal antigen in sperm of same gene is protective

  • active antibody to Angiotensin receptor 1(AAAT1)
    which activates AT1 receptors increase the sensivity to angiotensin and lead to hypertension
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10
Q

What the risks of the preeclampsia ?

A 
Maternal risks 
--------------------------
1- CNS problem as seizures and stroke 
2-renal failure 
3- hepatic failure or rupture 
4-DIC (Disseminated intravascular coagulation)
5-  CS
6- death 
Fetal risks 
------------------
1- prematurity 
2- IUGR
3- oligohydraminos 
4-placental infract 
5-placental abroption 
3- uretroplacental insufficiency 
4- prenatal death
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11
Q

whats happen to the blood picture to pt with preeclampsia ?

A

because the inflammatory mediators lead to vascular damage this lead to fibrosis so the blood component will destruct so the pt will have

  • high hematocrit (but if pt with anemia have normal hematocrit )
  • decrease the WBC thrombocytopenia
  • low platelet count (numbers correlate to the severity and abruption of the placenta )

-DIC due to the activation of the coagulation
or because over consumption of the coagulant lead to spuntaous heamorrge

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12
Q

what’s happen to the liver in the preeclampsia ?

A

1- hellps syndrom ( is a complication of pregnancy characterized by hemolysis, elevated liver enzymes, and a low platelet count.)

2- periportal heamorrhge

3- sub capsular bleeding

4- hepatic rupture __32% lead to mortality

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13
Q

what’s happen to the kidney in preeclampsia ?

A 
decrease the GFR 
lead to 
-oliguria 
- renal failure 
- uric acid and creatinine will elevated in the serum will the albumen will decrease
  • proteinuria
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14
Q

what’s the effect of the preeclampsia on the uteroplacental circulation ?

A
  • lead to uteroplacental insufficient
    -fetal complication as
    1- hypoxia
    2- IUGR
    3-prematurity
    4- placental abruption
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15
Q

what’s the symptoms and the signs of the preeclampsia ?

A

preeclampsia is sign disease

  • high PB
  • proteinuria (kidney)
  • edema of the face and hands
  • headache (CNS vascular damage Become leaky and lead to brain edema )
  • Exaggurated reflexes (CNS)
  • blurred vision
  • epigastric pain (liver )
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16
Q

what’re the preventive measures of the preeclampsia ?

A

1- Regular Antenatal checkups

  • see the weight if rapid gain
  • check PB
  • check for edema
  • liver na renal function test for proteinuria

2- Give the pt some of supplement as
- low dose of acorn in high risk group to increase the prostaglandin and decrease the TXA2

  • calcium supplement
  • Vit C & A as antioxidant
  • zinc , mg , fish oil , low slat diet
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17
Q

how to manage pt with gestational HTN at term ?

A
  • normal term is 40 weeks
  • delivery of the pt if pt in term
  • if the cervix is unfavorable and maternal disease is mild so close observation
18
Q

how to mange pt with gestational HTN and she is not in term ?

A
  • we should make sure if pt don’t have any sever disease
  • lab tests for the mother
  • antenatal fetal surveillance
  • then do conservative TRT
  • visit become twice a week
  • outpatient versus inpatient

Outpatient care is defined as hospital or medical facility care that you receive without being admitted or for a stay of less than 24 hours

Inpatient care refers to medical treatment that is provided in a hospital or other facility and requires at least one overnight stay. … For the purposes of healthcare coverage, health insurance plans require you to be formally admitted to a hospital for a stay for a service to be considered inpatient.

19
Q

what’r the indication of serger of pt with gestational HTN ?

A

1- the PB become worse
2- develop sever Pregnancy-Induced HypertensionPIH
3-if the fetal condition is not good
4- if the lung of fetus is mature
5- favorable cervix mean the cervix is dilated
give oxytocin
6- unfavorable and less than 32 week so CS

20
Q

when we do CS section or vaginal delivery in gestational HTN ?

A
  • If favorable cervix mean the cervix is dilated
    we give oxytocin and PG for cervix dilation

-if unfavorable cervix mean the cervix isn’t dilated so we do CS especially if the gestational age is les than 32 weeks

21
Q

is the prostaglandin contradicted ?

A

NO

22
Q

what’s the management of the preeclampsia ?

A

@ our goal or objective is to terminate the pregnancy with least danger to the mother or the fetus

1- we do first maternal investigation for

  • the hemoglobin and the hematocrit
  • platelet count which less100,000
  • liver function test
  • kidney function test raised urea and creatinine which normally decrease
  • urine test : proteinuria

2- then we do the management

or admitting the pt to the hospital especially

a) pt who develop high BP more or equal to 140/90
b) develop proteinuric with high BP
c) if the BP become more worse

  • then we stabilize the pt condition by
    a- anticonvulsant
    b- antihypertensive
    c- terminate the pregnancy
23
Q

what’re the anticovalsent thereby ?

A

Magnisum sulfate is commonly used
we give it with the onset of labor until 24h postpartum
and if CS will give her 2hr before the surgery until 12h postpartum

24
Q

whats the side effect of anticovalsent thereby ?

A 
MgSO4 
lead to maternal side effect 
--------------------------------------------
1- flushing 
2- headache 
3-muscle weakness
4-pulmanary edema
5- respiratory depression 
6- decrease the patellar reflex 
7- cardiac arrest 
fetal side effect 
----------------------------
1- lethargy 
2- hypotonia 
3-respiratory depression
25
Q

what the Mg levels ?

A
  • normal (1.7 - 2.4)
  • therapy (5 - 9)
  • lost of patellar reflex (more than 12 )
  • respiratory depression ( 15 - 20)
  • cardiac arrest (more than 25)
26
Q

how to mange the MGSO4 toxicity ?

A

1- stop the infusion
2- Give Ca 10mg over 10 min
3- endotracheal intubation

27
Q

what’s the antihypertensive treatment for the preeclampsia ?

A

-if mild BP 140/90
don’t give them the drugs
because if we use
+labetalol or nifedipine it will affect the fetus and cause IUGR

+ also ACI is contradicted because it cause IUGR , bone malformation, fracture ,Patent ductus arteriosus (PDA), pulmonary hypoplasia , RDS (respiratory distress syndrome) , hypertension , death .

-if sever 160/100
we use it to control the BP until delivery
and also use in preterm for 48h when give steroid for lung maturity to allow more time

28
Q

can we give antihypertensive drug for mild HTN ?

A

NO, because if we use
+labetalol or nifedipine it will affect the fetus and cause IUGR

+ also ACI is contradicted because it cause IUGR , bone malformation, fracture ,Patent ductus arteriosus (PDA), pulmonary hypoplasia , RDS (respiratory distress syndrome) , hypertension , death .

29
Q

what’re the antihypertensive therapy ?

A

*Hydralazine: 5-10 mg every 20 minutes
(thiazide diuretic)

  • Labetalol: 20mg, then 40, then 80 every 20 minutes,
    for a total of 220mg
    (beta-blocke)
  • Nifedipine: 10 mg po, not sublingual
    (calcium channel blockers)
  • Nitroprusside
    (vasodilator)
  • Diazoxide
    (Diazoxide is a thiazide drug, but has no diuretic (“water pill”) effects like other thiazides.This drug works by preventing insulin release from the pancreas, helping to return the blood sugar to normal levels)
  • Clonidine 1 mg po
    centrally acting alpha-agonist hypotensive agents

(p.o.: Abbreviation meaning by mouth, orally)

30
Q

whats the hellp syndrome ?

A

HELLP syndrome is a complication of pregnancy characterized by hemolysis, elevated liver enzymes, and a low platelet count

31
Q

how to diagnosis the hellp’s syndrome ?

A
  1. Hemolysis: H
    we take Peripheral smear result is↑bilirubin >1.2mg/dL,
  2. Elevated liver enzymes: L
    SGOT> 70 IU/L

3.Low platelets P

32
Q

how to manage the Hellps syndrome ?

A 
1- Immediate hospitalisation
2- Stabilise mother
- antihypertensives
- anti seizure prophylaxis
- correct coagulation abnormalities
3- Assess fetal condition
- FHR(fetal heart rate )
, doppler ultrasound
, biophysical profile

4-if it >34weeks gestation we do delivery
<34weeks expectant management if stable maternal
and fetal conditions

5- Platelet transfusion
if <40,000/mm3 before cesarean
I<20,000/mm3 before delivery

33
Q

what’re the indication termination of pregnancy?

A

1-Term pregnancy with mild or severe PET

2- Severe PET regardless of the gestational age
Warning signs headache , visual disturbance, epigastric pain, oliguria

3- Eclampsia Pt must be stabilized & delivered immediately Preterm with mild PET Assess fetal wellbeing by NST,
Doppler

34
Q

what’re the warning signs ?

A

headache , visual disturbance, epigastric pain, oliguria

35
Q

what’re the methods of delivery ?

A

+ induction of labour with prostaglandines to ripen the Cx followed by IV

+oxytocin ! Elective CS Severe PET with unfavorable Cx

36
Q

what’s eclampsia ?

A

its signs of preeclampsia with seizure

37
Q

what’s IR of eclampsia ?

A

0.1- 5.5 per 10,000 pregnancies but Decreasing incidence with time

38
Q

when the eclampsia mostly happen ?

A
  • Antepartum(50%): mostly in third trimester
  • Intrapartum(30%):
  • Postpartum(20%): usually within 48hours, fits beyond 7days generally rules out eclampsia
    المسلسل ماتت سبل بالكلامبسيا بعد الولاده
39
Q

what’re the risk factors of the eclampsia ?

A
  • Maternal age less than 20 years Multigravida
  • Molar pregnancy
  • Triploidy
  • Pre-existing hypertension or renal disease
  • Previous severe Preeclampsia or Eclampsia
  • Nonimmune hydrops fetalis
  • Systemic Lupus Erythematosus
40
Q

what’s the clinical feature of the eclampsia ?

A

convulsions are epileptiform and consist of four stages

➢Premonitory stage: twitching of muscles of face, tongue, limbs and eye. Eyeballs rolled or turned to one side, 30s

➢Tonic stage: opisthotonus(arching with rigid abdomen), limbs flexed, hands clenched, 30s

➢Clonic stage: 1-4 min, frothing, tongue bite, stertorous breathing

➢Stage of coma: variable period.

41
Q

what’re the magnet of eclampsia ?

A

1.call for help
2.put the patient in a left lateral position remove the clothes and
protect the tongue
3.artificial airway
4.blood should be taken for basal investigations
5.folley’s catheter
6.MgSO4
7.diazepam 10mg slowly and diluted which can repeated after 10 minutes
8. antihypertensive therapy
9.obstetrical examination to decide the mode of delivery then deliver the patient

Gyncology (15 decks)

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