Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

O&G > Hypertensive Disorders in Pregnancy > Flashcards

Hypertensive Disorders in Pregnancy Flashcards

1
Q

What are the normal blood pressure changes in pregnancy?

A
  • Decrease by around 30/15mmHg in the 2nd trimester

- Blood pressure then rises to pre-pregnancy levels by term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define pregnancy induced hypertension, and the type of disorder this encompasses

A

When BP >140/90mmHg after 20 weeks

Can be due to:

  • Pre-eclampsia
  • Gestational hypertension (new HTN after 20 weeks, without proteinuria)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define pre-existing or chronic hypertension during pregnancy

A

When BP >140/90 before pregnancy, or before 20 weeks

  • Can be primary or secondary (e.g to renal disease, Cushing’s etc.)
  • May be existing proteinuria because of renal disease
  • Pts with underlying HTN at increased risk of pre-eclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define pre-eclampsia

A

Multisystem syndrome, which manifests as new hypertension after 20 weeks, WITH significant proteinuria (>0.3g/24hr)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Outline the aetiology of pre-eclampsia

A
  • Impaired trophoblastic invasion into spinal arteries during placentation → oxidative stress
  • Resistance in uteroplacental circulation increases → leads to hypoperfusion and ischemia
  • Causes release of inflammatory mediators (sFlt-1, PIGF) → stimulating widespread endothelial damage, end organ
    dysfunction, oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the different classifications of pre-eclampsia

A

Classified based on degree of hypertension & presence of symptoms/biochemical/haematological impairment, and based on timing of manifestations

Degree of HTN (increases by 10s):

  • Mild: 140/90 to 149/99mmHg
  • Moderate: 150/100 to 159/09mmHg
  • Severe: 160/110+ mmHg

Degrees of pre-eclampsia:

  • Mild or moderate: no severe HTN, no symptoms, no biochemical nor haematological impairment
  • Severe: severe HTN and/or with symptoms, and/or biochemical and/or haematological impairment

Timing of manifestations:

  • Early: <34 weeks
  • Late: >34 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give some risk factors for the development of pre-eclampsia

A

High risk if (aspirin given if ANY of):

  • Previous hypertensive disease during pregnancy
  • CKD
  • Autoimmune disease (SLE, antiphospholipid syndrome)
  • T1DM, T2DM
  • Chronic HTN

Moderate risk (aspirin if >1 of):

  • Nulliparous
  • Age >40yrs
  • Pregnancy interval >10 years
  • BMI >35 at booking
  • FH of pre-eclampsia
  • Multiple pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the different ways urinary protein can be assessed, and the values in each method that classify proteinuria

A

Dipsticks (bedside):

  • Trace: NS
  • 1+: possibly significant proteinuria, quantify
  • ≥2+: significant proteinuria likely, quantify

PCR (protein:creatine ratio)
- >30mg/nmol: confirmed significant proteinuria

24hr collection
- >0.3g/24h: confirmed significant proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the clinical presentation of pre-eclampsia

A

History

  • Can be asymptomatic
  • Headache, visual disturbances
  • Drowsiness, nausea & vomiting
  • Epigastric pain

Examination

  • Elevated BP
  • Proteinuria
  • Oedema (more than expected, not postural)
  • Epigastric tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Outline some maternal complications, and the treatment for each of pre-eclampsia

A

Early onset disease is often more severe. Occurrence of complications is an indication for delivery, regardless of gestation:

  • Eclampsia: grand mal seizures –> hypoxia and mortality
    Treated with magnesium sulphate
  • Cerebrovascular haemorrhage
    Treatment of HTN should prevent this
  • Liver and coagulation problems: HELLP syndrome (Haemolysis - dark urine, raised LDH, EL: elevated liver enzymes, LP: low platelets)
    Treatment: supportive and magnesium sulphate prophylaxis for eclampsia
  • Renal failure
    Treatment may require haemodialysis
  • Pulmonary oedema
    Treatment with oxygen, furosemide, assisted ventilation may be required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Outline foetal complications of pre-eclampsia

A
  • Mortality and morbidity
  • Growth restriction (early onset pre-eclampsia)
  • Preterm delivery
  • Increased risk of placental abruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the investigations for diagnosis of pre-eclampsia and for identifying complications

A

Confirming diagnosis:

  • BP
  • Proteinuria (>0.3g/24hr, or >30mg/nmol on PCR)

Monitoring maternal complications

  • Bloods: uric acid, Hb, platelets, LDH, LFTs (ALT will rise in HELLPP), renal function (rapidly rising creatinine)
  • Eclampsia: CT head post-seizure

Monitoring foetal complications

  • US scan to estimate foetal weight
  • Umbilical artery Doppler, CTG (monitoring foetal well-being)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Outline some screening tools for picking up pre-eclampsia

A
  • Early: Uterine artery Doppler at 20/40

- Late: ratio of sFlt-1:PIGF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is used for prevention of pre-eclampsia?

A
  • Low dose aspirin (75mg) daily, starting before 16/40
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Simply outline the main domains of management for pre-eclampsia

A
  • Assessment: does pt require admission
  • Drugs
  • Timing of delivery
  • Conduct of delivery
  • Postnatal care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the criteria for admission in patients with pre-eclampsia and explain how pts not admitted are followed up

A

Criteria for admission

  • Symptoms
  • Proteinuria (>30 PCR, or >0.3g/24h)
  • Severe HTN
  • Growth restriction, abnormal umbilicate artery Doppler or abnormal CTG
  • Abnormal sFlt-1/PIGF assay

Patient’s not admitted are managed in outpatients

  • BP and urinalysis repeated x2 a week
  • US every 2-4 weeks
17
Q

Describe the medical management for pre-eclampsia

A

Antihypertensives (if BP reaches 150/100)
- Oral nifedipine, IV labetalol maintenance

Prevention of eclampsia
- IV Magnesium sulphate
Toxicity can cause respiratory depression and hypotension, which is preceded by loss of patellar reflexes (test regularly)

If magnesium is required, delivery is indicated
- Steroids to promote foetal lung maturity if <34/40

18
Q

Outline the timing of delivery in mothers with pre-eclampsia

A

Pre-eclampsia is cured only by delivery

  • Should be delivered by 36 weeks
  • <36 weeks: conservative management (steroids, intensive maternal and foetal surveillance, CTB, fluid balance)
19
Q

When does delivery usually take place for gestational hypertension?

A
  • Monitoring for deterioration

- Delivery by 40/40 is usual

20
Q

Describe the management of conduct of delivery in pre-eclampsia

A
  • <34/40: severe growth restriction –> C-section

> 34/40: induction with prostaglandins usually

  • Epidural
  • Foetal monitoring with CTG
  • Antihypertensives used in labour
  • If >160/110mmHg: avoid pushing in 2nd stage
  • Oxytocin rather than ergometrine for 3rd stage
21
Q

Describe the main management post-natally of mothers with pre-eclampsia

A

Often takes 24hrs for severe disease to improve, it can also worsen during this time

Bloods
- LFTs, platelets, renal function

Fluid balance

  • IV fluid restricted to 80mL/h (due to risk of pulmonary oedema)
  • Urine output monitoring: if CVP high, give furosemide, if CVP low, fluid is given

Blood pressure
- Maintained at 140/90
- Beta blocker
2nd line: nifedipine, ACEi

Long term management

  • Follow up with GP and midwives
  • If proteinuria and HTN persistent at 6 weeks: referral to renal or HTN clinic
22
Q

Describe the clinical features and complications of pre-existing hypertension in pregnancy

A

Clinical features

  • Symptoms usually absent
  • Proteinuria at booking
  • Secondary causes: renal bruits (RAS), radio-femoral delay (coarctation of aorta)

Complications

  • Pre-eclampsia
  • IUGR
  • Prematurity
  • Placental abruption
23
Q

Outline investigations for pre-existing hypertension in pregnancy

A

To identify secondary hypertension
- Two 24hr urine collections for VMA: to exclude pheochromocytoma
- Renal function, US
- Proteinuria, to identify any pre-eclampsia
(Proteinuria may be pre-existing due to pre-existing renal disease)

24
Q

Describe the management for pre-existing hypertension in pregnancy

A

Antihypertensives

  • Should be changed before pregnancy: ACEi are teratogenic
  • Labetalol
  • 2nd line: nifedipine

Risk of pre-eclampsia

  • High risk, so aspirin 75mg daily is required
  • Screening: uterine artery doppler, additional antenatal visits and scans to assess foetal growth

Delivery
- Usually 38-40 weeks

O&G (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions