O&G Written - HTN disorders Flashcards

1
Q

High risk factors for pre-eclampsia

A
Previous PET or HTN in pregnancy
Chronic kidney disease
T1 or T2DM
AI disease - SLE, anti-phospholipid syndrome
Chronic HTN
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2
Q

Moderate RF for pre-eclampsia

A
Primigravid
Age 40+
Pregnancy interval >10 years
BMI >35
Family Hx PET
Multiple pregnancy
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3
Q

Indication for prophylactic aspirin

A

1 + high risk factor or 2+ moderate RF = aspirin 75mg OD from 12 weeks onward

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4
Q

Medical management of PET

A

1st line = Labetalol (CAUTION: asthma)
2nd line - Nifedipine
3rd line = Methyldopa (CAUTION: depression)

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4
Q

Medical management of PET

A

1st line = Labetalol (CAUTION: asthma)
2nd line - Nifedipine
3rd line = Methyldopa (CAUTION: depression)

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5
Q

Target BP in pregnancy

A

<135/85 mmHg

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6
Q

Monitoring required in mild-moderate PET

A

Outpatient care (usually)

BP every 48 hours
FBC, LFT, U&E + urinalysis twice per week

USS at diagnosis and every 2-4 weeks (unless abnormal)

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7
Q

Management of eclamptic fit

A

A-E approach

IV magnesium sulphate loading dose 4g over 5-15 mins
THEN 1g/hour infusion - continued until 24 hours after last fit

+/- steroids if <34 weeks gestation
+ DELIVER baby

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8
Q

Signs of magnesium sulphate toxicity

A

Loss of patellar reflexes

THEN
Respiratory depression
Hypotension

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9
Q

Indications for delivery in PET

A

<34 weeks = monitoring UNLESS indications for early birth
-if so, give steroids + Mag Sulphate if delivery likely

34-36 weeks = consider risk: benefit
- offer steroids + IV mag sulphate if delivery likely

37+ weeks: birth within 24-48 hours

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10
Q

Principles of intra-partum care in PET

A

Measure BP hourly (mild-mod) or every 15-30 mins (severe)

Continue anti-HTN meds

Do not pre-load with fluids before epidural

Avoid maternal pushing if BP reaches 160/110 in 2nd stage

  • risks cerebral haemorrhage
  • operative / assisted birth!

Do not give ergometrine for active management of 3rd stage / PPH Tx

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11
Q

Post-partum anti HTN medications If breastfeeding

A

1st line = Enalapril (or Nifedipine if Black African / Caribbean)

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12
Q

What to do with anti HTN meds after delivery? (in PET)

A

If on methyldopa, switch within 2 days after birth

Consider reducing med if BP <140/90
Definitely reduce med if BP <130/80

R/v with GP in 2 weeks post-discharge

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13
Q

Follow up tests needed in PET?

A

R/v with GP in 2 weeks (if taking anti HTN meds) or 6-8 weeks otherwise

Urinary reagent strip test (urie dip?)
- if proteinuria –> review kidney function at 3 months

If abnormal kidney function –> specialist assessment for CKD

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14
Q

Recurrence stats in PET

A

15-16% recurrence of PET

20% experience HTN
6-12% experience gestational HTN
2% experience chronic HTN

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15
Q

Antenatal care for pre-existing HTN

A

Stop ACEi or ARB within 2 days of pregnancy notification

Offer alternative med

  • labetalol
  • nifedipine
  • methyldopa

Start aspirin 75 mg daily from 12 weeks

Usually additional antenatal appts + Foetal monitoring

  • umbilical artery doppler flow
  • USS for foetal growth + amniotic fluid
16
Q

Timing & mode of delivery in pre-existing HTN

A

If BP <160/110 do not offer delivery <37 weeks

After 37 weeks: discuss with mother + senior obstetrician