Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

A - ObsNGynae > Obs - hypertensive disorders > Flashcards

Obs - hypertensive disorders Flashcards

1
Q

How does blood pressure change in pregnancy and why?

A

reduces slightly in 2nd trimester: 30/15mmhg (or 15-20)

because of reduced SVR - systemic vascular resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how does protein excretion change in pregnancy?

A

increases but <0.3g/24h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what point in pregnancy do you see PREGNANCY INDUCED hypertensive disorders arise?

A

after 20 weeks - so well into 2nd trimester

this means if BP high before then, it was not induced by pregnancy -> Chronic HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the origin / aetiology of pre-eclampsia?

A

‘not completely understood’

placental in origin

Stage 1 (development):
incomplete trophoblast invasion

reduction in flow of blood in Spiral artery and Uteroplacental circulation

Stage 2 (manifestation):
Ischaemic placenta +
Exaggerated inflammatory response ->

Endothelial cell damage (virchow’s -> clotting) ->

increased vessel permeability (proteinuria + oedema) ->

vasoconstriction (HTN, Eclampsia, Liver damage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

define pre-eclampsia

A

Pre-eclampsia is a disorder of pregnancy characterized by hypertension (>140/90) & proteinuria (>0.3g/24h)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

list risk factors for pre-eclampsia?

A

nulliparity

previous pre-eclampsia
family hx pre-eclampsia

older mothers
chronic HTN

DM
Kidney disease
Twin pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the types of pre-eclampsia

A

Mild : 140/90 - 149/99

Moderate: 150/100 - 159/109

Severe - >160/110

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how may pre-eclampsia present?

A

Asymptomatic

Headache, drowsiness, nausea and vomiting

visual disturbances

epigastric pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what examination would you conduct for pre-eclapmsia?

A

Bedside:

BP - may not be high
Urine dip - protein (exclude infection with MC&S)
Fundoscopy - disc oedema

Neuro exam - reflex, eye movement
Abdo exam - epigastric tenderness (dic, liver failure, hellp)

Others:
24 hour urine collection
Protein:creatinine ratio >30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

complications of pre-eclampsia?

A

Maternal:

  1. Eclampsia - grand mal seizures
    • > death due to brain vessel spasm + hypoxia
    • > placental abruption
  2. Renal failure
  3. Pulmonary oedema
  4. HELLP syndrome (which has complications eg: DIC, abruption, renal failure)
  5. DIC
  6. Liver failure

more sever if earlier onset

Fetal:
IUGR, Stillbirth, Preterm delivery
If closer to term, less effect on growth. all gestatoins have equal risk abruption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is drug of choice in prophylaxis and treatment of eclampsia

A

magnesium sulphate - MgSO4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how would pulmonary oedema be managed?

A

furosemide and oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

list some fetal complications of pre-eclampsia? depending on date acquire?

A

IUGR - main problem if PET <34 wks
causing need for Preterm birth
Placental abruption

if PET around term:
Stillbirth
Placental abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what ivx would tell you some1 with pre-eclampsia is deteriorating?

A

fall in platelets - hellp

Low Hb - haemolysis (low haptoglobin too - haematocrit may be low or normal)

increased ALT - hellp, liver damge

increased LDH - haemolysis, liver damage

increased uric acid - very key feature!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how would you then monitor a baby?

A

US - fetal growth and weight

CTG

Umbilical artery doppler - key to outline prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how is PET mitigated?

A

All pregnant women have regular BP and urinalysis checks - come to the DAU

Aspirin 75mg before 16 weeks in at risk women

uterine artery doppler 23 weeks (not routine)

17
Q

where are PET patients managed? what is regular monitoring?

A
  1. Mild AND moderate -> OUTpatient care
    Assess DAU
    -> No proteinuria and mild/moderate htn are managed as outpatients and BP/urinalysis checked twice (▪ Mild: 1/week – Moderate: 2/week)
    weekly, with USS every 2-4 weeks
2. Admission criteria in suspected PET
A -> Symptoms
B -> Proteinuria 2+ ore more on dipsticks, or >0.3g/24h collection
C -> Diastolic BP >160/110mmHg
D -> Suspected fetal compromise

Admission is necessary with severe htn and where there is proteinuria

-> New proteinuria of 2+ should be admitted with or without HTN

Severe: manage in specialist unit with neonatal facilities

18
Q

how is PET managed? aim BP?

think this includes GHTN? review

A

Antihypertensives are given if BP reaches 150/100mmHg

Mod:
Labetalol

Severe:
1st - Oral Nifedipine
2nd - IV labetalol (usually contraindicated in severe)

+ IV MgSO4 - prevent eclampsia
+ Steroids

aim BP: 140/90

19
Q

what is the mechanism of MgSO4?

what sx does toxicity cause?

A

mechanism - increases cerebral perfusion

toxicity - respiratory depression, hypotension

20
Q

when do we deliver in pregnancy related HTN diseases?

A

Gestation htn - IOL 40wks

Mild PET - ‘deliver’ 37wks

Mod PET - deliver 34-36wks

Sev PET - deliver 34-36wks - more urgent, soon as steroids completed and BP stabilised

if sev with complications / fetal distress - deliver any gestation

delivery <34 wks - c-section
delivery >34 wks - IOL

21
Q

when does PET resolve?

A

within 24 hours post delivery

BP reach highest level 5days post birth

BUT may get worse!

22
Q

what does postnatal care of PET involve?

A

monitor closely -

bloods
urine output
BP - give labetalol. need long-term monitoring at GP

refer to renal clinic if persisting

23
Q

How does pre-existing hypertension present in pregnancy?

A

BP is already or rises above 140/90 before 20 weeks

may increase more in late pregnancy

may notice clinical signs of the cause: eg renal bruit, radiofemoral delay

proteinuria at booking - if kidney disease

24
Q

what are the causes of pre-existing hypertension in pregnancy?

A

Primary - essential HTN - Most common

Secondary - obesity, kidney disease (eg CKD),

 - rare; phaeo, cushings, aortic coarctation
 - heart disease
25
Q

management of pre-existing hypertension in pregnancy?

A

1st - labetalol

2nd - nifedipine

Low dose aspirin - mitigate pre-eclampsia risk

deliver by 40 weeks

take them off ACEinhibitors! (remember they would be on these if pre-existing htn)

26
Q

comlications and prognosis of pre-existing hypertension in pregnancy?

A

BP may drop in 2nd term
- may not need labetalol at that time

Risk of Pre-eclampsia

27
Q

What are the side effects of IV mgSO4 use?

how to monitor use?

A

Toxicity ->
respiratory depression and hypotension

Monitor: respiratory rate, SaO2, deep tendon reflexes (usually lost in TOXICITY)

28
Q

how to treat resp depression in mgso4 use?

A

calcium gluconate

29
Q

what findings on Umbilical artery doppler are worrying and indicate delivery?

A

Reduced End diastolic flow on UAD

30
Q

how is gestational HTN treated?

05/2021

A

Similar to pre-eclampsia

But first line for both Mod/Severe is Oral Labetalol

Same kind of monitoring with wholistic tests and Umbilical artery dopplers

-> they dont have proteinuria - so monitor to ensure it stays this way -> their main risk is developing PET
31
Q

How do we manage chronic hypertension HTN in pregnancy?

A

Pre-Pregnancy Advice:
1. Change ACE inhibitors or ARBs or chlorothiazide to:

Labetalol (or nifedipine 2nd line)

(due to increased risk of congenital abnormalities)
o Target BP < 150/100 mm Hg if uncomplicated hypertension

Monitoring:
A. ultrasound foetal growth, 
B. amniotic fluid volume assessment
C. 2x umbilical artery Doppler-> 28-30 and 32-34 weeks
D. BP and proteinuria
Lifestyle advice:
Advice keeping dietary salt intake low

Delivery:
If not severe (<160/100): Deliver after 37wks
If severe: steroids, early delivery

A - ObsNGynae (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions