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Y5 Gynae & Obstetrics > Hypertensive disorders > Flashcards

Hypertensive disorders Flashcards

1
Q

What are the classifications of hypertension severity?

A

Mild: 140-149, 90-99
Moderate: 150-159, 100-109
Severe: >160, >110

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2
Q

What are the three causes of hypertension in pregnancy?

A

Non proteinuric pregnancy induced HTN
Chronic HTN
Pre Eclampsia

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3
Q

Explain Non proteinuric pregnancy induced HTN

A

HTN rising for the first time in the second half of pregnancy in the absence of proteinuria

NO adverse pregnancy outcomes

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4
Q

What is the risk of Non proteinuric pregnancy induced HTN

A

That it goes on to become pre eclampsia (in 1/3)

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5
Q

What is pre eclampsia?

A

Hypertension of min 140/90 on 2 separate readings min 4h apart
+
Proteinuria of min 300mg protein in 24h collection of urine

Arising de novo after 20 wk gestation and resolving spontaneously within 6wk postpartum

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6
Q

What are RF for pre eclampsia?

A 
First pregnancy or >10 yrs since baby
Prior pre eclampsia 
FH pre eclampsia 
Age >40
BMI >35
Booking diastolic > 80 
Multiple pregnancy
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7
Q

Why does pre - eclampsia occur?

A

Development of abnormal placenta

  • Thromboblast invasion is patchy and poor
  • Spiral arteries retain muscular walls
  • This means placenta is POORLY PERFUSED > ischaemia

Uteroplacental ischaemia causes oxidative and inflammatory stress
This causes endothelial dysfunction, vasospasm, activation of coagulation system
Maternal body responds to poorly infused placenta by raising BP

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8
Q

What occurs to the CV system in PET?

A

Marked peripheral vasoconstriction > increase TPR (opposite of what should happen in pregnancy) > HTN

HTN+ loss of endothelial integrity causes OEDEMA

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9
Q

What occurs in the renal system in PET?

A

glomeriloendotheliosis

= impaired glomerular filtration, selective protein loss
Reduction in plasma oncotic pressur, exacerbate oedema

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10
Q

What occurs to the haem system in PET?

A

Diffuse vascular damage = laying down fibrin, platelet adherence

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11
Q

What occurs to the liver in PET?

A

Endothelial cell injury causes thrombi formation in microvasc

This causes reduced BF to liver
Liver injury
Liver enzymes released
Stretched liver capssule

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12
Q

What is HELLP?

A

Haemolyis
Elevated Liver enzymes
Low Platlets

Severe form of pre eclampsia
High total loss rate

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13
Q

What occurs to the Neuro system in pre eclampsia?

A

Vasospasm + cerebral oedema = seizures

Cerebral irritation = Clonus, hyperreflexia

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14
Q

What is eclampsia?

A

Presence of tonic clonic seizures in a woman with pre eclampsia in absence of other identifiable causes

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15
Q

What is the clinical presentation of pre eclampsia?

A

Headache (frontal)
Vision changes (blurring, scotoma due to decreased retinal blood flow)
Oedema - face and hands, widespread (due to endothelial injury + HTN)
Epigastric pain (reduced blood flow to liver > liver injury > liver enzymes released)
Malaise

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16
Q

What are signs of pre eclampsia ?

A

HTN
Epigastric teenderness
Hyperreflexia, clonus
Oliguria, proteinuria

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17
Q

What are complications of pre eclampsia?

A

Haemorrhagic stroke
Placental abruption
IUGR

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18
Q

What are maternal Ix for pre eclampsia?

A

FBC (low platelet count, high Htc)
Clotting
Renal profile
Liver profile

Repeat proteinuria quantification

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19
Q

What are foetal Ix in pre eclampsia?

A 
Abdo USS (foetal size, amniotic flayed volume, doppler) 
CTG (foetal distress)
20
Q

What is the cure of pre eclampsia=

A

ENDING the pregnancy by delivering the baabyby

21
Q

How do you manage PET?

A

LABETALOL PO if >150/100 (or nifedipine/methyldopa)

22
Q

What kind of medication is labetalol?

A

Alpha blocker

23
Q

What drug is given for eclampsia?

A

IV magnesium sulphate - neuroprotector

Causes cerebral vasodilation > reduces ischaemia generated by cerebral vasospasm

24
Q

What medication is given to prevent PET in high risk women?

A

ASPIRIN 75mg daily

25
Q

What is other management you must consider in women in pre eclampsia (given the other things she is at risk of?

A
  • Premature delivery > IM corticosteroids
  • VTE > Clexane (LMWH) + stockings
  • epidural if labour (helps control BP)
26
Q

What are indications of administration of IV magnesium sulphate?

A
  • Severe HTN + proteinuria
  • Eclamptic fit
  • Any Symptoms (headache, visual disturbance, epigastric pain, liver tenderness)
27
Q

What agents do you offer in chronic (NON PET) HTN?=

A

Labetalol (alpha blocker)
Nifedipine
Methydopa

28
Q

When do you treat chronic HTN?

A

If HTN > 150/100

29
Q

What is foetal growth restriction?

A

Failure of a foetus to achieve full genetic growth potential

30
Q

When is a baby considered small for gestational age (SGA)?

A

Baby below the 10th centile

31
Q

How can we categorise causes for SGA?

A

Reduced foetal growth potential

Reduced foetal growth support

32
Q

What are causes of Reduced foetal growth potential

\

A 
Aneuploiody 
Single gene defect 
Structural abnormality (e.g. renal genesis) 
Intrauterine infection
Foetal infection
33
Q

What are causes of reduced foetal growth support?

A

DECREASED BLOOD TO BABY

  • Reduced uteroplacental perfusion (poorly implanted, sickle cell)
  • Reduced foetoplacental perfusion (single umbilical artery, twin to twin transfusion)
34
Q

What do we also call Reduced foetal growth potential ?

A

Symmetrical

35
Q

What do we also cause reduced foetal growth support, and why?

A

Asymmetrical
Because of reduced blood flow to foetus due to uteroplacental insufficiency
This means more oxygenated blood from umbilical vein travels through ductus venous and liver gets little blood
This produces an ASYMMETRICAL foetus with brain sparing but reduced abdominal girth

36
Q

What does chronic foetal hypoxia present as on foetal blood test?

A

FOETAL ACIDOSIS (resp + metabolic)

37
Q

How do you detect and monitor SGA?

A
  • Accurate assessment of foetal gestation

- Recognition of foetal smallness (on growth chart, from CRL, HC, BPD, AC, FL)

38
Q

What are RF for FGR?

A

History of prior FGR
Multiple pregnancies
heavy smoker, drug user
Underlying maternal medical condition (HTN, DM, heart disease, APS)

39
Q

What is prognosis for FGR foetuses after delivery?

A

VERY GOOD if it was due to placental insufficiency
Infants catch up to peers
Because feeding is no longer dependent on placental ciculation

40
Q

Who are WOMEN CLASSIFIED As HIGH RISK of PET (i.e. will need aspirin)

A
  • Prior PET/HTN in gestation
  • Chronic HTN
  • CKD
  • DM
  • AI disease
41
Q

How long do you give aspirin for in high risk PET women?

A

12 to 36 week gestation to birth

42
Q

What is a common way of assessing proteinuria on the wards in PET?

A

SPOT protein : creatinine ratio

43
Q

After birth, how do you monitor a woman with gestational HTN?

A

Measure BP:

  • Daily for first two days
  • At least once days 3-5
44
Q

How do you change antiHTN tx after birth?

A

Change to ATENOLOL

45
Q

What PET women do you recommend birth in <34 weeks?

A

SEVERE HTN refractory to tx

Y5 Gynae & Obstetrics (34 decks)

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