Module 2: Hypertensive disorders in the perinatal period Flashcards
Pathophysiology of pre-eclampsia
A multi-system disorder characterised by hypertension and involvement of one or more organ system and/or the fetus.
Primary trigger is poor placental perfusion
Secondary trigger is related to reduced blood flow to major organs. Decreased bood flow to the placenta causes inadequate placental perfusion
Hypertension in pregnancy definition
The new onset of hypertension after 20 weeks gestation without any maternal or fetal features.
Systolic blood pressure >149mmHg and/or diastolic blood pressure >90mmHg
Risk factors for developing pre-eclampsia
Primigravidas
Women aged >40
Women with a new partner
Women with a past history or family history
Multiple pregnancies
Women with other medical conditions
Obesity BMI >35
Autoimmune diseases
Women using ART
Eclampsia definition
Eclampsia is the occurrence of seizures in the patient with pre-eclampsia
Pre-eclampsia definition
Hypertension arising after 20 weeks gestation and the onset of one or more of the following
* Significant dipstick proteinuria >30mg/mmol
* Renal insufficiency >0.9umol/L or oliguria
* Liver disease
* Neurological problems: severe headaches, persistent visual disturbances, hyper-reflexia with clonus, convulsions, stroke
* Hematological disturbances, thrombocytopenia
* Fetal growth restriction, placental abruption
Chronic hypertension (essential and secondary)
Essential hypertension: when BP >140 and >90 pre-conceptually or before 20 weeks.
Secondary hypertension: from medical causes
Severe hypertension
> 170mmHg and/or >110mmHg
Management considerations for hypertension
Pre-conception counselling
Risk factors and referral
Screening
Surveillance
Treatment options
Own institutional protocols
FMAU for BP profile
Admit to hospital if indicated
Education
Timing of delivery
Anti-hypertensives
Common medications for hypertension
Labetalol
Hydralazine
Methyldopa
Nifedipine
MgSO4 in emergency cases
What is HELLP
Haemolysis
Elevated liver enzymes
Low platelets
