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Hypertensive Disorders in Pregnancy Flashcards

1
Q

What is pregnancy-induced hypertension (PIH)?

A

Hypertension occurring >20 weeks gestation with no proteinuria

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1
Q

What is chronic hypertension in pregnancy?

A

Hypertension occurring <20 weeks gestation

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2
Q

What is pre-eclampsia?

A

Hypertension occurring >20 weeks gestation with proteinuria +/- oedema

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3
Q

What are the risks of hypertension in pregnancy?

A
  1. Pre-eclampsia
  2. Heart failure
  3. Stroke
  4. Placental abruption
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4
Q

What anti-hypertensives are suitable in pregnancy? Which should be withheld?

A

Labetalol, nifedipine, methyldopa

Withhold ACEi/ARB (teratogenic - oligohydramnios, kidney hypoplasia, renal failure)

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5
Q

When should you aim to deliver in chronic HTN/PIH?

A

38-39 weeks

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6
Q

How is chronic hypertension managed in pregnancy?

A
  1. Repeated measurements
  2. Cardiology consultation
  3. Medication (labetalol, nifedipine, low-dose aspirin)
  4. Aim to deliver by 38-39 weeks
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7
Q

Define pre-eclampsia.

A

Blood pressure >140/90 plus proteinuria measured on two occasions more than 6 hours apart at >20 weeks

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8
Q

What is the classic triad of signs in pre-eclampsia?

A

Hypertension, proteinuria and generalised oedema

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9
Q

Differentiate between mild and severe pre-eclampsia.

A

Mild BP >140/95
Severe BP >160/110

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10
Q

How is proteinuria measured in pre-eclampsia? (3 methods)

A

Urine dipstick
Protein:creatinine ratio (PCR) >30mg/mol
24hr urine collection >300mg/hr

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11
Q

What are the multi-system effects of pre-eclampsia?

A

Neurological - eclampsia
Cardiology - oedema
Renal - proteinuria
Hepatic - HELLP syndrome

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12
Q

What are the signs and symptoms of pre-eclampsia? (top to toe)

A

Headache, blurred vision, seizure
Facial swelling (puffy face)
Dyspnoea (pulmonary hypertension)
RUQ pain
Oligouria
Peripheral oedema
Clonus and hyperreflexia

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13
Q

What are the risk factors for pre-eclampsia?

A

Demographics
- African-American, maternal age, first pregnancy, twins
Obs History
- GDM, history of PET
Medical History
- essential hypertension, renal disease, DM

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14
Q

What are the 3 treatment goals in pre-eclampsia?

A
  1. Prevent seizures
  2. Lower BP to avoid cerebral haemorrhage
  3. Expedite delivery balancing maternal condition and foetal maturity
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15
Q

How is pre-eclampsia managed?

A
  1. Admit at 34 weeks and monitor (BP 4 hourly)
  2. Foetal condition (CTG, ultrasound, steroids)
  3. PET bloods
  4. Seizure prophylaxis (MgSO4)
  5. VTE prophylaxis (TEDs, heparin)
  6. Control BP (labetalol)
  7. Delivery
    - min 34w, ideally 37w IOL if cephalic
16
Q

What is involved in PET bloods?

A

FBC (Hb, MCV, platelets)
LFTs (haemolysis)
U+E (renal function)
Uric acid
Group and save

17
Q

What medication is used for seizure prophylaxis?

A

Magnesium sulphate (MgSO4)

18
Q

What is the first line treatment in PET? What are the second-line agents?

A

Labetalol 200mg BD

2nd line: nifedipine, hydralazine, methyldopa

19
Q

How is delivery expedited in PET?

A

Admit at 34 weeks, deliver by 37 w
- if 37 weeks and cephalic = IOL
- if <34 weeks or malpresentation = C-section

20
Q

Give 5 indications for C-section in PET.

A
  1. Seizures or uncontrolled BP
  2. Worsening bloods or proteinuria
  3. Non-reassuring CTG
  4. Absent or reversed EDF on Doppler’s
  5. Severe prematurity or unfavourable cervix
21
Q

How is PET managed in the post-partum stage?

A

MgSO4 for 24 hours
Monitor BP
Monitor UO
Avoid NSAIDs
Continue VTE prophylaxis
GP in 6/52 for BP check and PET bloods

22
Q

What medications are used in prevention of PET?

A

Aspirin 75mg up to 35 weeks
Calcium if Ca is low

23
Q

What are signs of MgSO4 toxicity?

A

Absent reflexes
Motor paralysis
Respiratory depression
Arrhythmia

24
Q

What are the complications of pre-eclampsia?

A

Severe pre-eclampsia
Eclampsia
HELLP syndrome

25
Q

What is eclampsia?

A

Occurrence of tonic-clonic seizures on a background diagnosis of pre-eclampsia

26
Q

When is the greatest risk of seizure in eclampsia?

A

In the first 24 hours post-partum

27
Q

What is the antidote for MgSO4 toxicity?

A

1g calcium gluconate over 10 minutes

28
Q

What is HELLP syndrome?

A

Variant of pre-eclampsia - haemolysis, elevated LFTs, low platelets

29
Q

How does a patient with HELLP syndrome present? What is the differential?

A

RUQ/epigastric pain, N+V, tea-coloured urine, high BP or symptomatic of pre-eclampsia

  1. Biliary colic/cholecystitis
  2. Hepatitis
  3. Pancreatitis
  4. GORD
  5. Renal colic

Obstetrics (17 decks)

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