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PHCY 320 > L 04 Hypertension, Preeclampsia, Diabetes > Flashcards

L 04 Hypertension, Preeclampsia, Diabetes Flashcards

1
Q

What is Hypertension and pre-eclampsia?

A

it is a condition vasospasm occurs during pregnancy in small and large arteries.

It is for mother blood can not go to the placenta.

It is also hinder blood flow to mother liver brain and placenta.

Around 7 to 8% mother suffer.

Happen after 20 weeks of pregnancy but if before 20 weeks then dr will determine as normal hypertension

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2
Q

Who is at risk for eclampsia?

A

Renal disease

Diabetics

Previous history

Antiphospholipid antibodies

Change in partners

Elevated BMI

Ethnicity

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3
Q

What is Chronic Hypertension

A

Pre-existing hypertension Sts 140 or above and Dia 90 or above

Presents 20 week of pregnancy and persist longer than 12 weeks

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4
Q

What is Gestational Hypertension

A

Sys 140 or above and Dia 90 or above

But it return of blood pressure to normal withing 3 months

Develop 20 weeks after gestation

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5
Q

What are the antihypertensive drugs during pregnancy? At NZ national guideline.

A

Labetalol

Nifedipine

Methyldopa

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6
Q

What does proteinuria mean?

A

Too much protein in the urine and its issue in the kidney

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7
Q

When patient experience Pre-eclampsia?

A

After 20 weeks of gestation hypertension onset.

Mother experience Proteinuria

Renal dysfunction like creatinine or urine output decrease

Liver dysfunction: ALT and AST level increase.

Neurological :Bad Headache (Red flag for pre- eclampsia)

Haematological complications: decrease platelets

Uteroplacental dysfunction: baby not growing well

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8
Q

What are the symptoms of pre-eclampsia?

A

Sudden wait gain

Swollen face hands and feet

Abdominal pain

Muscle twitching

Seizure and coma

Protein in urine

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9
Q

What are the features of severe preeclampsia in hospital?

A

Severe hypertension

Platelet count less

Impaired liver function

Renal insufficiency

Pulmonary edema

Seizures (during or before or after birth)

Headache and visual disturbances

We use IV hypertensive in hospital in severe cases

If it does not work then give MgSo (Magnesium sulphate)

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10
Q

What hospital needs to do for eclampsia seizures?

A

Need to inform Ministry of health

To identify why it happen how do we prevent this in future

Seizure are short lived

Delay Mg sulphate

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11
Q

Magnesium sulphate work?

A

They are Calcium antagonist, It reduces the resistance and increase vasodilation and relaxation, reduce blood pressure

Limit edema by reduce stress

Inhibit NMDA reception

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12
Q

What we need to be concerned of MgSo4 to pregnant women during seizure?

A

MgSO4 toxicity

It decreases respiratory rate and heart rate result respiratory paralysis

Heart block

Death

Collapse of circulatory system

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13
Q

Whey is preeclampsia/eclampsia is a problem?

A

In Baby:

Preterm birth

Placenta abrupt and child can birth

Blood pressure affect placenta

In Mother:

stroke

Seizure

Heart failure

Edema

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14
Q

How Management of Eclampsia?

A

Only cure is delivery(blood pressure will come to normal)

That can be virginal or caesarean section

Depends on severity

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15
Q

Important point to treat preeclampsia?

A

Low dose aspirin and calcium before 16 weeks reduce preeclampsia

Should be in hospital at inpatient

MgSO4 should be used in severe cases.

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16
Q

Developing high blood pressure during pregnancy always means you have preeclampsia

A

False

17
Q

Preeclampsia can cause seizures in pregnant women.

A

True

18
Q

What is Gestational Diabetes Mellitus or(GDM)?

A

Interconnect with preeclampsia

Didn’t had diabetes before pregnancy, comes in pregnancy and which goes away after finish pregnanc

19
Q

Why gestational diabetes are increases?

A

All mums are getting older

20
Q

Who is at risk of gestational diabetes?

A

Overweight

Older mother

Type 2 diabetes

Had Previous large baby

Genetics like Māori

21
Q

Why Gestational diabetes occur?

A

Because of hormonal changes, Lots of glucose and nutrient been made but need lot of insulin to clear those sugar nutrients from blood cause Gestational diabetes.

22
Q

What are the symptoms of gestational diabetes?

A

Usually No symptoms will show during gestational diabetes

Feels thirsty and exceptionally tired

Picked up at screening only

23
Q

Why insulin does not do its job to some mother during pregnancy?

A

Placenta is a system of vessels that passes the nutrients blood and water from mother to fetus.

The placenta makes certain hormones that prevent insulin from working the way that it should be worked

24
Q

During pregnancy does body need to produce insulin normal or higher?

A

Three times more than normal for normal metabolism

25
Q

What are the Screening for gestational diabetes?

A

HbA1c blood test before 20 weeks

LMC should offer a one hour, 50 g challenge test

26
Q

What if we do not treat gestational diabetes? What are the risks?

A

Baby grow bigger as they have more sugar and nutrients

Need caesarean section to deliver the baby

Increased chance of developing hypertension/preeclampsia

Change of getting UTI

For Baby:

Size of baby would be too big

Shoulder may dislocated during birth process

New born jaundice

Low level calcium in blood

Respiratory distrace

27
Q

How much additional food would you recommend a pregnant women to eat?

A

First trimester(first 12 weeks) there is No need any extra food

But after 32 weeks an extra sandwich

28
Q

What are the management of gestational diabetes in pregnancy?

A

Weight and blood glucose goals

Eat healthy

Healthy lifestyle interventions

Maintain MoH NZ recommended BMI to reduce C-section

29
Q

What is the healthy weight according to NZ MoH guidelines?

A

Healthy people gain 11.5 to 16kg weight during pregnancy

When baby comes out it may be 3-4 kgs

30
Q

Diet for Women of gestational diabetes?

A

175 g carb/day

Reduce intake of saturated fats

Spreading carbohydrates evenly throughout the day

Consume lean protein

Physical activity add here next slide

31
Q

Physical activity during pregnancy for diabetic pregnant women?

A

Moderate physical activity in30 min 5 days a week

Who are less active women can start 10-15min and gradually increase to 30 min

32
Q

Diabetic Pregnant women should not do ?

A

Based on their situation and physical condition

If they are too taired

Do not do activity laying on your back on 2nd and 3r trimester

Perform activity in hot weather

Activity that you may bump or hurt

33
Q

Self monitoring needs to perform for diabetic mother during pregnancy?

A

Monitoring

Blood glucose

Diet

Exercise

If not achieved glycaemic target then go for medication

34
Q

Pharmacological options for diabetic mother?

A

Insulin (first line)

Metformin (use as alternative of insulin)

Safe in pregnancy

Women should be informed that this meds passes’ placenta

35
Q

What is the postpartum management for gestational diabetes management?

A

Encourage breastfeeding

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PHCY 320 (7 decks)

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