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.