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Obstetrics > Hypertensive disorders in pregnancy (PET) EMERGENCY > Flashcards

Hypertensive disorders in pregnancy (PET) EMERGENCY Flashcards

1
Q

What is normal to see in BP in the 1st trimester of pregnancy?

A

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

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2
Q

What is HTN due to pre-eclampsia caused by?

A

increase in peripheral resitance

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3
Q

What is pre-existing HTN defined as

A

> 140/90 before 20 weeks gestation or pregnancy (can be essential or secondary).

there is no proteinuria or oedema

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4
Q

What is pregnancy induced HTN (PIH) defined as

A

> 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

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5
Q

What is pre-eclampsia defined as?

A

new-onset HTN + proteinuria (> 0.3g /24 hrs) after 20 weeks gestation

oedema can occur

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6
Q

What are the two stages of PET?

A

Placental disease = < 20 weeks, asymptomatic

Maternal response = ? 20 weeks and symptomatic

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7
Q

What is the pathophysiology of the placental disease?

A

failure of trophoblastic invasion of sprial arterioles leading to maladpation of these vessels leaving them vasoactive.

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8
Q

What does maternal inflammatory response to the ischaemic placenta induce?

A

endothelial damage -> vasoconstriction, increased permeability and clotting dysfunction

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9
Q

What are RF for PET (9)

A
  1. > 40 years old
  2. Nulliparity or new partner
  3. multiple pregnancy
  4. BMI > 30 kg/m2
  5. DM
  6. Pregnancy interval of more than 10 years
  7. Family history or previous history
  8. pre-existing vascular disease such as HTN or renal disease
  9. low PAPP-A
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10
Q

What are some symptoms of pre-eclampsia?

A 
headache
RUQ pain or epigastric
flashing lights / visual disturbances
N+V 
swelling of face, fingers and lower limbs
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11
Q

What are some signs of PET? (5)

A 
papilloedema 
>2 beats of clonus 
placental abruption 
IUGR
stillbirth
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12
Q

What should you do if urine dipstick is positive in PET

A

exclude infection with urine MC&S

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13
Q

What is diagnostic of HTN in PCR (protein creatinine ratio)

A

> 30 mg/nmol

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14
Q

what does a rapid drop in platelets and raised LFTs indicate?

A

impending HELLP syndrome

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15
Q

When should you hospitilise for new onset HTN? (3)

A
  1. symptomatic
  2. > 160/110 / proteinura >0.4 g/24h
  3. foetal compromise
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16
Q

What medication do you give if BP > 160/100

A

Oral labetalol - aim for BP of 140/90

Nifedipine + hydralazine may also be used

17
Q

What do you give for prevention and treatment of eclampsia?

A

magnesium sulphate infusion

(increases cerebral perfusion)

treatment = give IV bolus of 4g over 5-10 minutes followed by infusion of 1g/hour

18
Q

What is the first sign of toxicity in eclampsia?

A

loss of patellar reflexes

19
Q

After last seizure or delivery how long should treatment continue for?

A

for 24 hours

20
Q

What do you give for magnesium sulphate toxicity

A

Calcium gluconate (resp distress)

21
Q

What else can you do for eclampsia?

A

fluid restriction if severe

corticosteroids for foetal lung maturation

22
Q

what is the only cure for PET?

A

delivery

23
Q

What is eclampsia (obstetric emergency)

A

Tonic-clonic seizures + pre-eclampsia

24
Q

What is the management of eclampsia? (4)

A

resuscitate
MgSo4 for seizures
Labetalol, restrict fluids for HTN
deliver

25
Q

What does HELLP stand for

A 
Haemolysis 
Elevated 
Liver ezymes
Low 
Platelets
26
Q

What does HELLP present with?

A

epigastric / RUQ pain
N&V
dark urine due to haemolysis

27
Q

What is the management for HELLP?

A
  1. rescuscitate
  2. MgSO4 for seizures
  3. Labetalol, fluid restirtion fot HTN
  4. deliver
28
Q

How do you treat renal failure?

A

fluid

dialysis if severe

29
Q

What are some feotal complications of PET? (4)

A

IUGR
pre-term birth
placental disruption (abdominal pain, uterine enlargement, vaginal bleeding - deliver baby)
death

Obstetrics (4 decks)

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