Hypertensive disorder: Week 2

Question 1

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Answer 1

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Question 2

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Answer 2

Mild hypertension–Systolic 140-149–Diastolic 90-99•

Question 3

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Answer 3

Moderate hypertension–Systolic 150-159 mmHg–Diastolic 100-109 mmHg•

Question 4

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Answer 4

Severe (hypertensive emergency)–Systolic 160 mmHg or more–Diastolic 110 mmHg or more–MAP of 125 and above•
Remember to compare to booking reading – BP lowers during the second trimester

Question 5

MAP

Answer 5

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Question 6

What is chronic hypertension?

Answer 6

Chronic hypertension•Hypertension that predates a pregnancy or appears prior to 20 weeks of gestation•

Question 7

What is gestational hypertension?

Answer 7

Gestational Hypertension•New hypertension presenting after 20 weeks without significant proteinurea•

Question 8

What is pre-eclampsia?

Answer 8

Pre-eclampsia•Hypertension new to pregnancy manifesting after 20 weeks of gestation that is associated with a new onset of proteinuria•

Question 9

What is severe pre-eclampsia?

Answer 9

Severe pre-eclampsia•Pre-eclampsia with severe hypertension (Systolic blood pressure is 160 mmHg or greater, diastolic blood pressure is 110 mmHg or greater

Question 10

What is eclampsia?

Answer 10

•Eclampsia•Convulsive condition associated with pre-eclampsia

Question 11

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Answer 11

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Question 12

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Answer 12

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Question 13

Pre-eclampsia

Answer 13

Multisystem disorder linked to pregnancy •Hypertension associated with proteinuria•Tends to occur in 2nd half of pregnancymaternal morbidity & mortalityneonatal morbidity & mortality•Incidence ranges from 2-8% of primips, depending on population studied (more common in Latin America & Caribbean) & criteria used to diagnose the disorder•Aetiology = widespread endothelial cell damage secondary to an ischaemic placenta

Question 14

Pre-eclampsia 2

Answer 14

Often asystomatic until in an advanced state•Can evolve within weeks or hoursrisk of hypertension and cardiovascular disease in later life

Question 15

What are the risk factors for pre-eclampsia?

Answer 15

• First pregnancy (highest risk)
• Previous history of pre-eclampsia
• Change of partner (autoimmune)
• 10 years or more since last baby
• Aged 40 years or more or teenager
• BMI of 35+
• Family history e.g. mother, sister etc.
• Pre-existing hypertension
• Pre-existing diabetes
• Renal disease
• Autoimmune disease (eg Systemic lupus erthyematosus, antiphospholipid syndrome
• Booking BP /80+
• Booking proteinuria 1+
• 1+ protein on more than one occasion or 300mg in 24 hours
• Multiple pregnancy
• Underlying medical conditions e.g. renal / cardiovascular disease / diabetes
• Latin American or Caribbean
• Donor eggs (autoimmune)
• Post-partum: headache for 1-3 days (check BP)

Question 16

What pre-eclamptic symptoms should be assessed antenatally?

Answer 16

• New and / or significant proteinuria (≥ 1+)
• Maternal symptoms of headache and / or visual disturbances (e.g. blurring / flashing)
• Epigastric pain (below ribs) or vomiting (like really bad indigestion)
• Reduced fetal movements or small for dates
• Sudden & marked oedema –Face / hands / feet–oedema occurs in 80% of pregnant women, so routine questioning abandoned

Question 17

Potential complications of severe pre-eclampsia

Answer 17

Papilloedema- eyeballs swell- take OFF contact lenses

Question 18

Maternal complications?

Answer 18

Intracranial haemorrhage (leading cause of death from severe pre-eclamptic toxaemia in UK)•Placental abruption•Eclampsia•HELLP syndrome•Disemminated Intravascular Coagulation (bleeding into tissues- blood can’t clot)•Renal failure•Pulmonary oedema•Acute respiratory distress syndrome (often leads on from pulmonary oedema )

Question 19

What are the fetal complications?

Answer 19

Fetal growth restriction•Oligohydramnios•Hypoxia from placental insufficiency•Placental abruption•Premature delivery

Question 20

Clinical Signs

Answer 20

Systolic BP 160-180mmHg or…•Diastolic ≥ 110mmHg•MAP ≥ 125•Protein 0.3g per 24 hours or where the protein:creatinine ratio is greater than 30mg, •Elevated serum creatinine >100mmol/l•Elevated liver enzymes ALT >70iu/l•Oliguria (less than 500 mls per 24 hours)•Pulmonary oedema•Microangiopathic haemolysis•Thrombocytopenia•Cerebral or visual disturbances•Epigastric pain•Hyperreflexia –(over-responsive reflexes may indicate onset of eclampsia (repeated beats of clonus)

Question 21

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Answer 21

asthmatics shouldn’t be given labetalol if they can’t take non-steroidal anti-inflammatory drugs Like ibuprofen
Afro-caribbean also can’t tolerate

Question 22

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Answer 22

asthmatics shouldn’t be given labetalol if they can’t take non-steroidal anti-inflammatory drugs Like ibuprofen
Afro-caribbean also can’t tolerate - nifedipine instead, sx doses 10g
Works within 30 mins, 200mg
Mag sulphate- 400mg/200mg/1-200mg- to prevent eclamptic fit
When BP spontaneously drops after being extremely high and oulse drops (without medication)- indicative of stroke or haemorrhage because body is closed circuit and heart compensates for increased pressure