Obstetrics Flashcards
Hypertension before how many weeks reflects pre-existing hypertension.
13
Hypertension in pregnancy is?
The commonest medical problem in pregnancy affecting between 10 and 15 % of all pregnancies. It is a group of conditions that include PIH Pre-existing hypertension Pre-eclampsia Eclampsia
HELLP SYNDROME AND AFLP part of same spectrum
What is PIH?
Significant rise in blood pressure after 20 weeks without proteinuria or other signs of preeclampsia. Usually mild with bp of 140/90. 15% with PIH will develop pre-e. Early onset 20-24 40% chance, mild rises after 37 weeks 10%.
Risk factors for PIH?
Primiparity or first child new partner. Previous severe pre-e Essential hypertension Diabetes Obesity Renal disease Over 40 Pre-existing cardiovascular disease Cushing's disease
What is pre-eclampsia?
Hypertension associated with proteinuria developing after 20 weeks gestation. It may also be associate with excessive peripheral oedema. Oedema of face and fingers likely to represent pre-e as lower limb oedema common.
As early as 20 weeks but more commonly between 24-28 weeks.
What causes pre-eclampsia?
Not fully understood but thought to be due to the normal physiological changes in the uterus blood vessels not occurring. Due to either abnormal endothelial function ( lining of the small vessels) or a factor produced by trophoblast. Leads to poor perfusion of the placenta and growth restriction of the fetus.
What are the stats for pre-eclampsia deaths?
In the 2007 CEMACH report pre-e was responsible for 18/132 13.6% of maternal deaths related direct pregnancy causes. Second leading cause of maternal deaths equal with sepsis in the UK.
Risk factors for pre-eclampsia?
Primiparity or first child new partner. Previous severe pre-e Essential hypertension Diabetes Obesity Twins or multiple Renal disease Over 40 Under 16 Pre-existing cardiovascular disease Cushing's disease
What is severe pre-eclampsia?
May present in a patient with known pre-e or may present with little prior warning. Blood pressure significantly raised 160/110 with proteinuria and one or more of the following:
Headache severe and frontal
Visual disturbances
Epigastric pain (stretching of liver capsule)
Right-sided upper abdominal pain (stretching of liver capsule)
Muscle twitching or tremor
Nausea vomiting confusion
Rapidly progressive oedema
Is a multi organ disease Intracranial haemorrhage Stroke Renal failure Liver failure Abnormal blood clotting Placental abruption and associated massive haemorrhage
What are time critical features of severe pre-eclampsia?
Headache severe frontal Visual disturbances Epigastric pain Right-sided upper ab pain Muscle twitching or tremor Confusion
What is pre-hospital management of pre-eclampsia?
15-30 left lateral tilt
Inform hospital of arrival
Secure IV access
DO NOT give routine IV fluids as risk of developing pulmonary oedema.
What was one of the top ten recommendations from recent CEMACH report affecting prehospital care?
A new systolic of 160 or diastolic of 110 or higher should trigger automatic admission to obstetric unit. Reduce chance of intracerebral haemorrhage and stroke. CEMACH 2007
What is the pre-hospital management of eclampsia?
Lateral tilt Open protect airway O2 if indicated - details Time critical Per alert Magnesium sulphate 4 g loading IV or io over 15 mins, dose then 1g/ hour at hospital.
How is eclampsia diagnosed?
Presence or history of tonic-clonic seizures after 20 weeks gestation.
How does eclampsia present?
Usually have pre existing mild/moderate/severe pre-e but can present acutely with no warning. One third present for first time post delivery usually in first 48 hours.
Possible for BP to be only mildly elevated 140/80-90.
