Hypertensive Disorders of Pregnancy Flashcards

1
Q

Define the difference between

  • Chronic HTN
  • Gestational HTN/ Pregnancy-induced HTN
  • Pre-eclampsia
  • Eclampsia.
A

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.

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2
Q

What are the RF for pre-eclampsia?

A

Obstetric factors (rejection leading to poor placental development)

  • Primiparity + Primipaternity
  • Short duration of sexual relationship (antibody dev.)

Conditions leading to ischemia–> poor placental developement:

  1. Obstetric factors
    - Multiple pregnancy
    - GDM
  2. Social factors:

>35 years.

  • Obesity
  • Family history
    3. Comorbidities:
  • Renal disease
  • Antiphospholipid syndrome.
  • SLE.
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3
Q

What are the systemic effects of Hypertensive Disease of pregnancy and what is their underlying pathophysiology?

A

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

  1. Neurological
    - hyperreflexia w sustained clonus.
    - persistent h/a
    - persistent visual disturbance: photophobia, scotomata.
    - seizures.
  2. HELLP
    - haemolysis
    - liver dysfunction + necrosis, swelling + subcapsular haematoma.
    - thrombocytopenia
  3. kidneys:
    - glomerular dysfunction
    - proteinuria.
  4. Fetus:
    - IUGR
    - placental abruption.
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4
Q

What is seen in history and examination in someone with pre-eclampsia?

A

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.
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5
Q

What investigations are done in someone suspected of pre-eclampsia, and what is seen in the results?

A

BLOODS

  1. FBC:
    - Hb: low.
    - Platelets: <100 000 u/L
    2: UEC
    - Creatinine ratio >30.
  2. LFT
    - AST>40 u/L
    - ALT >40 u/L
  3. 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.
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6
Q

What is the treatment for pre-eclampsia?

A

Early: antihypertensive medication

  • methyldopa
  • labetalol hydrochloride
  • nifedipine
  • hydralazine

Term:

  • delivery.
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7
Q

What is the management of a woman in an acute eclamptic attack?

A
  1. Call for help
  2. airways - clear airway
  3. breathing - check o2 sats.
  4. circulation - check cardiac output, insert bore cannula, take bloods (FBC, LFT, UEC, Glucose).
  5. Displacement - ensure she is on her left side to prevent IVC compression.
  6. Drugs - magnesium sulfate (neuroprotective + vasodilatory effect).
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8
Q

What ongoing investigations are done on a woman with pre-eclampsia?

A

Urinalysis for protein

+ Pre eclampsia bloods

  • FBC
  • LFTs
  • UECs
  • creatinine ratio.
  • SLE, kidney function, antiphospholipid syndrome, thrombophilias (especially if severe, early onset).
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