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Midwifery Emergencies > Hypertensive disorders > Flashcards

Hypertensive disorders Flashcards

1
Q

What is the definition of hypertension in pregnancy?

A

2 x readings pf 140/90 at least 4 hours apart
or
1 diastolic reading of 110

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2
Q

What are the 3 types of hypertension?

A

mild
moderate
severe

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3
Q

What is mild hypertension?

A

140-149/

90-99

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4
Q

What is moderate hypertension?

A

150-159/

100-109

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5
Q

What is severe hypertension? (emergency)

A

160+/110+

MAP of 125+

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6
Q

When does BP lower?

A

second trimester

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7
Q

What is MAP?

A

mean arterial pressure - average or mean value for arterial pressure represents pressure driving the blood through the arteries

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8
Q

How do you calculate map?

A

diastolic pressure+ 1/3 (systolic pressure - diastolic pressure)

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9
Q

What is chronic hypertension?

A

hypertension that predates a pregnancy or appears prior to 20/40 - may be superimposed or secondary to another medical condition

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10
Q

What is gestational hypertension?

A

New hypertension presenting after 20 weeks without significant proteinurea

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11
Q

What is pre-eclampsia?

A

Hypertension new to pregnancy manifesting after 20 weeks associated with new onset of proteinurea

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12
Q

What is severe pre-eclampsia?

A

pre-eclampsia with severe hypertension (160+/110+)

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13
Q

What is eclampsia?

A

convulsive condition associated with pre-eclampsia

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14
Q

When does gestational hypertension resolve?

A

usually 6 weeks postnatally

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15
Q

What is pre-eclampsia caused by?

A

Widespread endothelial cell damage secondary to ischaemic placenta

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16
Q

What risks are there for later life if you have pre-eclampsia?

A

Hypertension and cardiovascular disease

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17
Q

Lower/other risk factors for pre-eclampsia

A
  • new partner
  • booking bp /80+ or booking proteinurea 1+
  • 1+ protein on more than one
  • latin american or carribean
  • donor eggs - other DNA
  • postpartum - headache for 1-3 days
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18
Q

What can women be prescribed at booking if higher risk?

A

75mg aspiring from 12 weeks till birth

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19
Q

what does aspirin do?

A

changes how the placenta imbeds

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20
Q

What are the 5 high risk factors?

A
  • prev hypertensive disorder in pregnancy
  • chronic kidney disease
  • autoimmune disease
  • type 1 or 2 diabetes
  • chronic hypertension
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21
Q

What are the moderate risk factors?

A
  • primip
  • age 40+
  • pregnancy interval of 10+ years
  • BMI or 35+
  • family hx of pre-eclampsia
  • multiple pregnancy
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22
Q

Antenatatal symptoms

A
  • new hypertension
  • new or significant proteinurea >1+
  • mat symptoms of headache or visual disturbances
  • epigastric pain or vomiting
  • rfm or small for dates
  • sudden and marked oedema- face/hands/ feet
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23
Q

Signs of severe pre-eclampsia

A 
-hypertension >160/110 with proteinuria 
OR 
->3+ proteinurea 
OR 
-thrombocytopenia - reduced platelets (<100)
-creatinine >100 mmol/l
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24
Q

What are the 8 maternal complications of pre-eclampsia?

A
  • intracranial haemorrhage
  • placental abruption
  • eclampsia
  • HELLP syndrome
  • Disemminated intravascular coagulation
  • Renal failure
  • Pulmonary oedema
  • Acute respiratory distress syndrome
25
Q

What is the leading cause of death from severe pre-eclampsia in the UK?

A

intracranial haemorrhage

26
Q

What is HELLP syndrome?

A

H- haemolysis
EL- elevated liver enzymes
LP- low platelets

27
Q

What is Disemminated intravascular coagulation?

A

A condition in which blood clots form throughout the body’s small blood vessels which reduce or block floor- damages organs. The increased clotting uses up platelets and clotting factors. With less of thees, serious bleeding can occur. It can cause internal and external bleeding.

28
Q

What is renal failure?

A

Due to not passing urine, increased fluid in the body leaks into the tissues due to high blood pressure, leads to oedema

29
Q

What is acute respiratory distress syndrome?

A

infections, injuries and other conditions cause fluid to build up in air sacs. Prevents lungs from filling with air and moving enough oxygen into the bloodstream.

30
Q

What are fetal complications of pre-eclampsia?

A
  • fetal growth restriction
  • oligohydramnios
  • hypoxia from placental insufficiency
  • placental abruption
  • premature delivery
31
Q

Clinical signs of pre-eclampsia

A
  • BP 160-180 or /110
  • MAP >125
  • protein 3+ in 24 hrs
  • elevated serum creatinine
  • elevated liver enzymes
  • oliguria
  • pulmonary oedema
  • microangiopathic haemolysis
  • thrombocytopenia
  • cerebral or visual disturbances
  • epigastric pain
  • hyperreflexia - more twitchy on relfex tests more likely to fit
32
Q

What happens to bloods in pre-eclampsia?

A
    • haemoglobin due to haemoconcentration
    • haematocrit due to -plasma volume - leaking out
    • platelets due to aggregation following damage to lining of blood vessels
    • uric acid - serial measurements more useful
    • urates
33
Q

What is haematocrit?

A

how much space in the blood is occupied by red blood cells - if they take up more space they are usually bigger and vice versa

34
Q

When do we act for high blood pressure?

A
  • check BP and urinalysis at every visit
  • systolic >150 - hypertensives
  • systolic >180 - emergency
  • if >140 or /90 2x or immediately after birth - consultant unit
35
Q

What is the timing of eclampsia?

A

38% antenatally
18% intrapartum
44% postnatally

36
Q

What is the death rate for those who have eclamptic fits?

A

2%

37
Q

Management of eclampsia - basic

A
  • key people told
  • basic life support - abc
  • prevent seizures - mag sulf
  • lower bp - labetalol oral/IV OR nifedipine oral OR hydralazine IV
38
Q

What are the drugs used to lower BP in emergencies?

A

1st line - labetalol
2nd line - nifidipine
3rd line- hydralazine

39
Q

How do we give labetalol?

A
  • initial oral dose 200mg
  • second oral dose given if needed
  • maintenance dose 200mg
  • If oral not working or non tolerable - IV
  • Bolus 50mg IV given over 5 minutes
  • repeat if BP >160/105 in doses of 50mg up to 200mg at 10 minute intervals
  • After give infusion of labetalol 5mg/hour at a rate of 4ml/hr
  • double rate every 1/2 hour up to 32 ml/hour
  • bradycardia countered with IV atropine sulphate 0.6-2.4mg in divided doses of 600mcg
40
Q

When should we not give labetalol?

A

asthmatic

afrocarribean

41
Q

What does labetalol do?

A

beta blocker- blocks beta receptors with control heart rate and smooth muscle contractility

  • compete with adrenaline
  • reduces peripheral resistance
  • protects heart from reflex sympathetic drive
42
Q

What is methyldopa for?

A

mild-moderate hypertension in pregnancy, also known as aldomet. acts on brain stem. counteracts effects of epinephrine, norepinephrine and dopamine. inhibits sympathetic nervous system causing vasodilation and bradycardia

43
Q

How do we give nifedipine?

A
  • 10mg orally
  • repeat every 30 mins until max 30mg given
  • can be given with labetalol
  • may give if map >120
  • calcium channel blocker
  • maintenance dose 10mg qds
44
Q

What does nifidipine do?

A

inhibits passage of calcium ions into smooth muscle reducing contractility
allows arterioles to dilate and decreases bp
hr increases which can cause myocardial ischaemia

45
Q

How do we give hydralazine

A

Bolus given 5mg over 15mins
Can give further 5mg after 20 mins if BP >160
-Maintenance IVI starting at 5ml/hr to titrate BP to 140-150
-usual rate 2-3ml/hr
-reduce rate if mat hr >120

46
Q

What can rapid reduction in BP cause?

A

cardiovascular collapse
myocardial ischaemia
compromise fetal oxygen supply

47
Q

3 main ways to manage eclampsia

A

monitor symptoms
maintain fluid balance
expedite delivery

48
Q

How do we monitor symptoms for eclampsia?

A
  • hourly basic obs
  • resps
  • neurological obs
  • sats
  • ECG
  • CVP
  • urgent bloods
  • CTG
49
Q

How do we maintain fluid balance for eclampsia?

A
  • restrict hourly input - 1ml/kg/hr

- hourly urine output via urometer

50
Q

What can overloading fluid cause?

A

pulmonary oedema

51
Q

What should be controlled before a CS under GA?

A

BP

52
Q

Why should BP be controlled for GA?

A

pressor effects of intubation- intubation increases BP, reflex response and is momentary but can be enough to raise intracranial pressure

53
Q

What are the 3 outcomes of extremely high BP?

A

Give anti- hypertensive
Placental abruption
Intracranial haeomorrhage

54
Q

What does a sudden drop in bp and no antihypertensive given mean?

A

bleeding

55
Q

What should you consider for pre-eclamptic women for an epidural?

A
  • Low platelets- risk of bleeding

- Fluid before due to hypotension- could cause fluid overload in PET women

56
Q

What are the signs of magnesium toxicity?

A
  1. loss of reflexes
  2. somnolence
  3. respiratory depression
  4. paralysis
  5. cardiac arrest
57
Q

What is the antidote to magnesium toxicity?

A

calcium gluconate

58
Q

What is magnesium toxicity?

A

hypermagnesemia

Midwifery Emergencies (7 decks)

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