Obstetrics and gynaecological disorders Flashcards
What is pre-eclampsia ?
a disorder of pregnancy that is associated with a new onset of hypertension
what is the BP range for pre-eclampsia?
> 140 mm Hg systolic
90 mm Hg diastolic
When is pre-eclampsia most common (time frame) in pregnancy?
most often in 2nd trimester after 20 weeks gestation and frequently near term
What symptoms often come with pre-eclampsia?
- new onset proteinuria
- oedema (hands and face) - swelling caused by too much fluid trapped in body fluid
What are the non-modifiable factors for pre-eclampsia?
- history of pre-eclampsia
- chronic hypertension
- first pregnancy
- new paternity (2nd baby diff dad)
- age - very young <16 and mother >35
- race - black women are at higher risk
- multiple pregnancy (twins triplets) increased BP
- history of other conditions - migrants, diabetes T1, T2, kidney disease, clotting disorders, clotting disorders, lupus, cardiovascular disease.
- In vitro fertilisation (IVF)
- large gap between pregnancy - 10yrs + since last pregnancy
What are the modifiable factors for pre-eclampsia?
- obesity
- stress (mum stress affects baby)
What is the pathology behind why you get proteinuria ?
hypertension -> nephrons in kidneys need very accurate BP to filter properly -> due to hypertension they don’t filter properly -> proteins not absorbed properly -> end up in urine
Whta is the pathology behind why you get pre-ecampsia ?
the hypoxic foetus releases antibodies (in reaction to poor perfusion) that cause vasoconstriction (of mums vessels) - to try and increase BP to increase blood supply to the foetus
- the RAAS (monitors your BP) is affected by the pre-eclampsia and not sufficient to manage blood pressure. (during pregnancy system is already less effective and even less in pre-eclamptic patients) RAAS system is no longer effective at managing BP
The signs and symptom of pre-eclampsia can be different depending on the severity of their hypertension, what are the signs?
BP >140/90 mm Hg ?
mild/moderate
oedema
proteinuria
signs and symptoms of severe pre-eclampsia ?
BP >160/110 mm Hg
oedema (rapidly progressing)
proteinuria (with one or more of the following)
- severe frontal headache
- visual disturbances
- epigastric pain
- visual disturbances
- R-sided upper abdominal pain
- muscle twitching or tremor
- nausea
- vomiting
- confusion
Sign and symptoms of very severe pre-eclampsia ?
it can progress to :
- inter cranial haemorrhage
- stroke
- renal faiulre
- liver failure
- convulsions
- abnormal blood clotting such as disseminated intravascular coagulation (DIC)
How do you manage/treat mild or moderate pre-eclampsia ?
assess patient and look for signs of severe pre-eclampsia
if mild symptoms discuss with booked obstetric unit or midwife
How do you manage/ treat severe pre-eclampsia?
- assess for signs of severe pre-eclampsia, monitor BP, SPO2 (target range 94-98%) and BM
early delivery/ c-section may be required - if associated symptoms will not resolve and foetal demands are still present - Avoid fluid administration
DO NOT DELAY TRANSPORT
must keep pt as calm as possible
do not lie flat, consider left lateral - protect airway and treat hypoxia
- diazepam if seizures over 2-3 min
- advanced paras may give magnesium sulphate
What is the placenta, its job, and where it is in normal pregnancy ?
an organ which develops during pregnancy
is the connection between the mother and foetus
- it exchanges nutrients, blood and O2
- the normal placenta will embed itself at the top of the uterus attaching to the endometrium.
What is placenta previa and when does it happen?
> 20 weeks gestation
- previa - placenta fully occludes the cervix restricting the passage of the fetus
