L 04 Hypertension, Preeclampsia, Diabetes Flashcards
What is Hypertension and pre-eclampsia?
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
Who is at risk for eclampsia?
Renal disease
Diabetics
Previous history
Antiphospholipid antibodies
Change in partners
Elevated BMI
Ethnicity
What is Chronic Hypertension
Pre-existing hypertension Sts 140 or above and Dia 90 or above
Presents 20 week of pregnancy and persist longer than 12 weeks
What is Gestational Hypertension
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
What are the antihypertensive drugs during pregnancy? At NZ national guideline.
Labetalol
Nifedipine
Methyldopa
What does proteinuria mean?
Too much protein in the urine and its issue in the kidney
When patient experience Pre-eclampsia?
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
What are the symptoms of pre-eclampsia?
Sudden wait gain
Swollen face hands and feet
Abdominal pain
Muscle twitching
Seizure and coma
Protein in urine
What are the features of severe preeclampsia in hospital?
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)
What hospital needs to do for eclampsia seizures?
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
Magnesium sulphate work?
They are Calcium antagonist, It reduces the resistance and increase vasodilation and relaxation, reduce blood pressure
Limit edema by reduce stress
Inhibit NMDA reception
What we need to be concerned of MgSo4 to pregnant women during seizure?
MgSO4 toxicity
It decreases respiratory rate and heart rate result respiratory paralysis
Heart block
Death
Collapse of circulatory system
Whey is preeclampsia/eclampsia is a problem?
In Baby:
Preterm birth
Placenta abrupt and child can birth
Blood pressure affect placenta
In Mother:
stroke
Seizure
Heart failure
Edema
How Management of Eclampsia?
Only cure is delivery(blood pressure will come to normal)
That can be virginal or caesarean section
Depends on severity
Important point to treat preeclampsia?
Low dose aspirin and calcium before 16 weeks reduce preeclampsia
Should be in hospital at inpatient
MgSO4 should be used in severe cases.
Developing high blood pressure during pregnancy always means you have preeclampsia
False
Preeclampsia can cause seizures in pregnant women.
True
What is Gestational Diabetes Mellitus or(GDM)?
Interconnect with preeclampsia
Didn’t had diabetes before pregnancy, comes in pregnancy and which goes away after finish pregnanc
Why gestational diabetes are increases?
All mums are getting older
Who is at risk of gestational diabetes?
Overweight
Older mother
Type 2 diabetes
Had Previous large baby
Genetics like Māori
Why Gestational diabetes occur?
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.
What are the symptoms of gestational diabetes?
Usually No symptoms will show during gestational diabetes
Feels thirsty and exceptionally tired
Picked up at screening only
Why insulin does not do its job to some mother during pregnancy?
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
During pregnancy does body need to produce insulin normal or higher?
Three times more than normal for normal metabolism
What are the Screening for gestational diabetes?
HbA1c blood test before 20 weeks
LMC should offer a one hour, 50 g challenge test
What if we do not treat gestational diabetes? What are the risks?
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
How much additional food would you recommend a pregnant women to eat?
First trimester(first 12 weeks) there is No need any extra food
But after 32 weeks an extra sandwich
What are the management of gestational diabetes in pregnancy?
Weight and blood glucose goals
Eat healthy
Healthy lifestyle interventions
Maintain MoH NZ recommended BMI to reduce C-section
What is the healthy weight according to NZ MoH guidelines?
Healthy people gain 11.5 to 16kg weight during pregnancy
When baby comes out it may be 3-4 kgs
Diet for Women of gestational diabetes?
175 g carb/day
Reduce intake of saturated fats
Spreading carbohydrates evenly throughout the day
Consume lean protein
Physical activity add here next slide
Physical activity during pregnancy for diabetic pregnant women?
Moderate physical activity in30 min 5 days a week
Who are less active women can start 10-15min and gradually increase to 30 min
Diabetic Pregnant women should not do ?
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
Self monitoring needs to perform for diabetic mother during pregnancy?
Monitoring
Blood glucose
Diet
Exercise
If not achieved glycaemic target then go for medication
Pharmacological options for diabetic mother?
Insulin (first line)
Metformin (use as alternative of insulin)
Safe in pregnancy
Women should be informed that this meds passes’ placenta
What is the postpartum management for gestational diabetes management?
Encourage breastfeeding
Re-screen
