Hypertensive Disorders of Pregnancy Flashcards
Define the difference between
- Chronic HTN
- Gestational HTN/ Pregnancy-induced HTN
- Pre-eclampsia
- Eclampsia.
Chronic HTN.
- BP > 140/90
primary: existing prior to 20weeks
secondary: due to another cause, ie - hyperaldosteronism, renal parenchymal disorders.
Gestational HTN/PIH
BP > 140/90, after 20 weeks, due to no other cause.
Pre-eclampsia
BP > 140/90.
+ sign of systemic disease (ie, proteinuria).
Eclampsia
Seizures brought on by high ICP in a woman who is pre-eclamptic. Absence of another cause.
What are the RF for pre-eclampsia?
Obstetric factors (rejection leading to poor placental development)
- Primiparity + Primipaternity
- Short duration of sexual relationship (antibody dev.)
Conditions leading to ischemia–> poor placental developement:
- Obstetric factors
- Multiple pregnancy
- GDM - Social factors:
>35 years.
- Obesity
- Family history
3. Comorbidities: - Renal disease
- Antiphospholipid syndrome.
- SLE.
What are the systemic effects of Hypertensive Disease of pregnancy and what is their underlying pathophysiology?
Underlying Pathophys:
Defective placental vascular remodeling (weeks 16-22)->inadequate placental perfusion–> release of antiangiogenic factors -> destroys VEGF
Low VEGF -> dysfunctional maternal endothelium -> endothelial damage
-> platelet adhesion + activation of CC.
–> ischemia: kidneys, liver, brain.
Synctiotrophoblast debri -> maternal inflammatory response: leucocytes -> activation of CC, activation of platelets.
Result
General:
- platelet activation + cc activation
- endothelial dysfunction, ischemia at liver, kidneys, brain.
Effects
- Neurological
- hyperreflexia w sustained clonus.
- persistent h/a
- persistent visual disturbance: photophobia, scotomata.
- seizures. - HELLP
- haemolysis
- liver dysfunction + necrosis, swelling + subcapsular haematoma.
- thrombocytopenia - kidneys:
- glomerular dysfunction
- proteinuria. - Fetus:
- IUGR
- placental abruption.
What is seen in history and examination in someone with pre-eclampsia?
HISTORY
- headaches (persistent)
- tiredness
- visual disturbances
- urination frequency
- R epigastric pain.
- frequent urination/frothy urine.
EXAM
- high BP
- Abdo: epigastric tenderness, hepatomegaly.
- Uterus: size, fundal height, liquor volume, tone, tenderness - signs of IUGR/placental abruption.
- Neuro exam: hyperreflexia with clonus, visual disturbances.
What investigations are done in someone suspected of pre-eclampsia, and what is seen in the results?
BLOODS
- FBC:
- Hb: low.
- Platelets: <100 000 u/L
2: UEC
- Creatinine ratio >30. - LFT
- AST>40 u/L
- ALT >40 u/L - Urinalysis: 24 hour urine
- 0.3g over 24 hour samples.
- 2+ persistently elevated protein on urine dipstick.
Baby:
- CTG
- US
- Doppler: UA, CA, uterine artery.
What is the treatment for pre-eclampsia?
Early: antihypertensive medication
- methyldopa
- labetalol hydrochloride
- nifedipine
- hydralazine
Term:
- delivery.
What is the management of a woman in an acute eclamptic attack?
- Call for help
- airways - clear airway
- breathing - check o2 sats.
- circulation - check cardiac output, insert bore cannula, take bloods (FBC, LFT, UEC, Glucose).
- Displacement - ensure she is on her left side to prevent IVC compression.
- Drugs - magnesium sulfate (neuroprotective + vasodilatory effect).
What ongoing investigations are done on a woman with pre-eclampsia?
Urinalysis for protein
+ Pre eclampsia bloods
- FBC
- LFTs
- UECs
- creatinine ratio.
- SLE, kidney function, antiphospholipid syndrome, thrombophilias (especially if severe, early onset).