Hypertensive Disorders Flashcards
Risks of chronic hypertension x3
Increased risk of developing pet
Increased risk of iugr
Increased risk of placental abrupt ion
Degrees of chronic hypertension
Mild, moderate and severe
Definition of mild chronic hypertension
140-149/90-99
Definition of moderate chronic hypertension
150-159/100-109
Definition of severe chronic hypertension
> 160/>110
Pregnancy induced hypertension
Development of blood pressure above 140/90 after 20/40 without proteinuria
Risks of PIH x1
Increased risk of PET
Antenatal care for a patient with PIH x3
Regular A/N checks - bp and urinalysis
Education on symptoms of PET
Anti hypertensives if BP persistently >150/90
Maternal Risk factors for PET x6
Maternal family hx Personal hx of condition Ethnic background Greater interval between pregnancies Age 40 Multiple pregnancy
Medical disorder risk factors for PET x6
Chronic hypertension Renal disease Obesity Diabetes mellitus Adverse lipid profile Thromboembolic disorders
Systems affected by PET x5
Cardiovascular Renal Liver Neurological Fetoplacental
When will signs of PET show
2nd half of pregnancy
Interplay of factors resulting in PET x3
Genetic predisposition
Immunological
Placental development/implantation
Placenta ischiaemia - pregnancies complicated by PET point 1
2nd wave of trophoblast cell invasion of spiral arterioles in 2nd trimester is abnormal = impaired perfusion of placental tissue
Placenta ischiaemia - pregnancies complicated by PET point 2
Spiral arteries remain intact endothelial and smooth muscle linings. They undergo less dilitation than expected.
Placenta ischiaemia - pregnancies affected by PET point 3
Development differences are thought to result in factors being released into maternal circulation.
These could be responsible for placental dysfunction, vasoconstriction and hypertension.
Placenta ischiaemia - damage to endothelial cells will: x4
Reduce production of prostacyclin and nitric oxide
Increase vascular sensitivity to angiotension 2
Activates coagulation cascade and production of thromboxane
Increases production of lipid per oxides and decreases antitoxidants
Placenta ischiaemia - a result of endothelial dysfunction
Circulating factors are released from placenta in response to hypoxia resulting from under perfusion
Placenta ischiaemia - what do endothelial cells form?
Endothelium
Placenta ischiaemia - what do endothelium do? X4
Line cv system
Play role in regulating capillary transport
Role in modulating vascular smooth muscle reactivity in response to various stimuli
Form inner lining of blood vessels
What study suggests length of sexual relationship is related to incidence of PET?
Robillard et al 1994
What is a sexual relationship of
A 7 fold increase in HDP
Partial explanation for increase incidence of HDP with x5
Nulliparity Primiparity Teenage pregnancy Aids Previous hx of pet with male partner
Effects of placenta ischaemia and endothelial disruption x9
Generalised vasoconstriction Increase systemic vascular resistance Increase vascular hydrostatic pressure Decrease in tissue perfusion Multiple organ dysfunction/damage Increase in vascular permeability Oedema Decrease in circulating plasma volume Haemoconcentration
Maternal symptoms - brain vasospams x3
Frontal headaches
Visual disturbances
Seizures
Maternal symptoms - liver micro emboli/hypoxic damage x4
Liver swelling
Nausea and vomiting
Epigastric pain
Right upper quadrant pain
Screening for hypertensive disorders properties x4
For those that have risks/signs at booking or f/u
Continuity care results in less mistakes
Regular bp and urinalysis
Observe for oedema
What is the best way to measure bp?
Manually as it is the optimum method for diagnosis
What must we consider when measuring bp? X5
Effects of physical condition, exertion, environment, smoking, white coat syndrome
Proteinuria x3
Dipstick measurement
If proteinuria present obtain for msu
Confirm using qualitative measurement and timed urine
What is RBC x2
Main blood component
Helps asses O2 carrying capacity
Variation in normal RBC count x2
Increase may indicate polcythaemia
Decrease may indicate anaemia, fluid overload and haemorrhage
What does haematocrit value tell us
Reflects % of blood occupied by RBC
Normal haematocrit value
35-47%
Variation in haematocrit levels x2
Decrease in level may mean anaemia, MOH
Increase in levels = polycythaemia
Haemoglobin
Main component of RBC
Normal hb level
11 - 14 g/dl
Variation in levels of hb x2
Increased levels may = haemoconcentration
Decreased levels may = anaemia, recent haemorrhage, fluid retention
PLT normal value
150-400 x 109/l
PLT role x2
Role in forming blood clots
Role in haemostat in process
Increased PLT x5
Haemorrhage Pet Hellp Dic Idiopathic thrombocytopenia
When do C-reactive protein concentration increase x2
During inflammation and infection
What happens to GFR and u + e if excretion ability of kidney is compromised
Decreased GFR
U and e accumulate in blood
Serum concentration of both rise
Normal urea level
2.5 - 6.4
Normal creatinine level in pregnancy
44-73 mmol/l
How can liver dysfunction be measured x2
By increased blood levels of various enzymes and metabolises usually cleared by liver
What might increased levels of ALP enzyme indicate? X2
Hepatic and placental damage
What is the role of albumin x2
Main plasma protein
Influences movement of fluid within capillaries
Normal albumin value
Around 38g/l
What does damage to capillaries in pet cause? X 2
Extra satin of plasma
Loss of plasma protein eg albumin
What will low albumin levels result in
Indication for urgent delivery
Neurological assessment x3
Cerebral vasospams
Cerebral oedema
Deep tendon reflexes
Aims of antenatal treatment x 6
Prevent maternal death Prolong pregnancy (why) Monitor mother closely Control bp Prevent seizures Aim for optimum delivery before compromise
When would antihypertensive therapy be considered?
With women systolic bp >150
Where would we like to maintain diastolic bp
90-110
Fetal assessment x3
Ultrasound growth scan/rate
Doppler ultrasound assessment
Biophysical profile
Chronic hypertension
Blood pressure of 140/90 or > before 20/40
