Hypertensive disorders in pregnancy (PET) EMERGENCY Flashcards
What is normal to see in BP in the 1st trimester of pregnancy?
fall by approx 30/15 particularly diastolic and continue to fall until 20-24 weeks due to reduction in peripheral resistance
then it rises to pre-pregnancy levels
What is HTN due to pre-eclampsia caused by?
increase in peripheral resitance
What is pre-existing HTN defined as
> 140/90 before 20 weeks gestation or pregnancy (can be essential or secondary).
there is no proteinuria or oedema
What is pregnancy induced HTN (PIH) defined as
> 140/90 after 20 weeks gestation but no proteinuria or oedema and resolves following birth but are at increased risk of pre-eclampsia in the future
What is pre-eclampsia defined as?
new-onset HTN + proteinuria (> 0.3g /24 hrs) after 20 weeks gestation
oedema can occur
What are the two stages of PET?
Placental disease = < 20 weeks, asymptomatic
Maternal response = ? 20 weeks and symptomatic
What is the pathophysiology of the placental disease?
failure of trophoblastic invasion of sprial arterioles leading to maladpation of these vessels leaving them vasoactive.
What does maternal inflammatory response to the ischaemic placenta induce?
endothelial damage -> vasoconstriction, increased permeability and clotting dysfunction
What are RF for PET (9)
- > 40 years old
- Nulliparity or new partner
- multiple pregnancy
- BMI > 30 kg/m2
- DM
- Pregnancy interval of more than 10 years
- Family history or previous history
- pre-existing vascular disease such as HTN or renal disease
- low PAPP-A
What are some symptoms of pre-eclampsia?
headache RUQ pain or epigastric flashing lights / visual disturbances N+V swelling of face, fingers and lower limbs
What are some signs of PET? (5)
papilloedema >2 beats of clonus placental abruption IUGR stillbirth
What should you do if urine dipstick is positive in PET
exclude infection with urine MC&S
What is diagnostic of HTN in PCR (protein creatinine ratio)
> 30 mg/nmol
what does a rapid drop in platelets and raised LFTs indicate?
impending HELLP syndrome
When should you hospitilise for new onset HTN? (3)
- symptomatic
- > 160/110 / proteinura >0.4 g/24h
- foetal compromise
What medication do you give if BP > 160/100
Oral labetalol - aim for BP of 140/90
Nifedipine + hydralazine may also be used
What do you give for prevention and treatment of eclampsia?
magnesium sulphate infusion
(increases cerebral perfusion)
treatment = give IV bolus of 4g over 5-10 minutes followed by infusion of 1g/hour
What is the first sign of toxicity in eclampsia?
loss of patellar reflexes
After last seizure or delivery how long should treatment continue for?
for 24 hours
What do you give for magnesium sulphate toxicity
Calcium gluconate (resp distress)
What else can you do for eclampsia?
fluid restriction if severe
corticosteroids for foetal lung maturation
what is the only cure for PET?
delivery
What is eclampsia (obstetric emergency)
Tonic-clonic seizures + pre-eclampsia
What is the management of eclampsia? (4)
resuscitate
MgSo4 for seizures
Labetalol, restrict fluids for HTN
deliver
