Hypertensive disorders Flashcards
commonest cause of death in preeclampsia
Intracranial Hemorrhage
placental biomarkers that if increase predict PET
- Soluble fms-like tyrosine kinase 1 S-FLT1
- Soluble Endoglin SEND
- BHCG
- FFDNA (relaesed by dead placental trophoblasts
placental biomarkers that if decrease predict PET
- Placental like Growth Factor PlGF
- pregnancy associated plasma protein
- vascular endothelial growth factor
- ADAM 12
when we do uterine artery doppler to predict PET
1st or 2nd trimester
the most accurate test to predict PET
Uterine artery doppler (diastolic notch)
81% of women w/ early onset PET
is Ca deficiency a risk factor for PET
yes
as it increases prothormone that increases intracellular calcium leading to vasocinstriction
Recommended dose of VIT D for all pregnant women and PET
for all women: 400mcg/d
in PET: 800 mcg/d + Ca
in high risk of vit D deficiency: 1000 mcg
when we give Calcium sup.
after 20 w
1.5-2 g elemental Calcium
What is chronic HTN
HTN that presents before 20 w if the women already taking anti-HTN prior to pregnancy
pregnancy care in chronic htn in pregnancy
-Stop ACEI, ARBs and theothiazides
- Encourage low Na diet
- Target BP 135/85
Anti-hypetresive drugs safe in pregnancy
1st - Labetalol
2nd -Nifedipine
3rd - Methyldopa
When to take Aspirin in case of HTN/PE
Aspirin 75-150mg/d from 12 weeks, if one of these:
- HTN during pvs preg.
- chronic kidney dis.
- Autimmune dis.
- DM type 1 or type 2
- Chronic HTN
or 2 of these:
- (1) 1st preg.
- (2) twins
- (10) preg. interval >10 y
- (35) BMI 35 kg/m2
- (40) >40 years
- family hx
when to offer PIGF test to rule out PET
20 - 36+6 Weeks if women w/ CHTN suspected to have PET
Antenatal Appointment in Chronic HTN
- if Well controlled: every 2-4 w
- if poor controlled: weekly
postpartum manegement of CHTN
- BP daily 1,2,4
- keep BP less than 140/90
- review anti-htn durgs after 2 weeks of birth
When to stop methyldopa after delivery and why
take it only for 2 days then return to preconception antihypertensive, as it causes PP depression
CHTN
when to offer a medical review postpartum
6-8 weeks
Proteinuria used to diagnose PET
- dipstick +1
- PCR >30 mg/mmol
ACR> 8 mg/mmol
Do mild/moderate/sever GHTN need admission
Mild/Moderate- outpatient
Severe- inpatient
Measure BP in mild/moderate/sever GHTN
mild/moderate: once or twice weeks
sever: on monitor every 15-30 mins until BP <160/110
Test for proteinuria in mild/moderate/sever GHTN
mild/moderate: once or twice with BP measurement
sever: daily while admitted
when to do Blood test in mild/moderate/sever GHTN
CBC, livver enz., renal functions at presentation then weekly
Low PAPPA may lead to
Increases risk of:
- PET
- TRIOSOMY
- SGA
when to do U/S in mild/moderate/sever PET
mild/moderate: at diagnosis -> if normal every 2-4 w, if clincally indicated
sever: at diagnosis -> if normal every 2w, if clincally indicated
Timing of birth in GHTN
After 37 w ->if bp <160/110 , w/ or w/o ttt
if refractory sever-> terminate after course of corticosteroids (if required) +/- MgSo4
The only indication to use amlodipine as anti-htn
- in Black africans or Caribbeans
- she was using it before and controlled her condition
We save hydralazine in which patients?
In ICU
Antihypertensive to be used and avoided in Asthmatic patients
- give nifedipine
- avoid beta blockers and ACEI: generate dry cough
Central chest pain radiating to central back and left jaw & left upper arm
Central back: dissecting aortic aneurysm
Left jaw and upper arm: MI
