Pathology during Pregnancy Flashcards
What are the complications of gestational hypertension?
Pre-eclampsia
Chronic hypertension
Inc lifetime CV risk
What disorders put women at high risk of pre-eclampsia?
HTN disease during a prev pregnancy CKD Autoimmune disease (SLE, antiphospholipid syndrome) Type1 &2 DM Chronic HTN
How should women at high risk of pre-eclampsia be treated?
75mg Aspirin daily for 12weeks until the birth of the baby
What is the target BP for uncomplicated chronic hypertension?
150/100mmHg
Why should ACE/ARBs not be used in pregnancy?
Inc risk of congenital abnormalities
What should be offered to women with pre-eclampsia postpartum?
Medical review at 6-8weeks after birth
Define chronic hypertension
Hypertension that is present at the booking visit or before 20 weeks or if the woman is already taking antihypertensive medication when referred to maternity services. It can be primary or secondary in aetiology.
Define gestational hypertension
New hypertension presenting after 20 weeks without significant proteinuria.
Define pre-eclampsia & eclampsia
Pre-eclampsia: New hypertension presenting after 20 weeks with significant proteinuria
Eclampsia: Convulsions in the presence of pre-eclampsia diagnostic factors due to brain hypoxia from oedema & vasospasm
What components make up HELLP Syndrome?
Haemolysis, elevated liver enzymes and low platelet count.
What are the symptoms of pre-eclampsia?
Severe headache Problems with vision: Blurring, flashing Severe pain below the ribs Vomiting Sudden swelling of the face, hands, feet Hyper-reflexia Proteinuria Oliguria Spont bleeding
How should chronic hypertension be monitored after birth?
- Daily BP for first 2 days after birth
- BP at least once between 3-5days after birth
- Continue antenatal antihypertensives
What risk factors need to be taken into account in gestational hypertension/pre-eclampsia?
- Nulliparity, twins/triplets
- > 40 OR <20
- Pregnancy interval >10years
- FHx/prev Hx of pre-eclampsia
- BMI >35
- Multiple pregnancy
- Pre-existing vascular/renal disease
- Chronic HTN
How should gestational hypertension be managed?
Mild: Conservative
Moderate: Labetalol, measure BP x2/week, measure proteinuria every visit
Severe: Labetalol, measure BP 4/day, measure proteinuria daily
In gestational hypertension what is considered mild, moderate & severe?
Mild: 140/90
Moderate: 150/100
Severe: 160/110
When in gestational hypertension would you consider delivery?
37weeks
Severe gestational HTN >160/110
When in pre-eclampsia would delivery be considered?
Pre-eclampsia at 34-36weeks
What fetal monitoring should be done in a woman with hypertension?
Chronic: USS- fatal growth, amniotic fluid vol, umbilical artery doppler between 28-30weeks & 32-34weeks, CTG if activity abnormal
What treatment should be given to a patient with pre-eclampsia who has a convulsion?
IV Magnesium Sulphate- continued >24hrs after delivery
Use: Prevention & termination of fit
Which antihypertensive medications have no effects on babies receiving breast milk? Describe them
Labetalol: 1st line
Nifedipine: CCB & VasoD, used w/Labetalol or if CI
Atenolol
Metoprolol
Methyldopa: Centrally acting stimulates beta adrenergic receptors, dec total peripheral vascular resistance
Hydralazine: Unknown mechanism, vasodilation arterioles & reduce BP
Which medications should not be advised in breast feeding or preconceptually?
BF: ARBs, Amlodipine, ACEi, Statins (also discontinued in pregnancy)
Pre: Gliclazide, ACEi, ARB, Statin
Which complications are more common in women with pre-existing diabetes?
Miscarriage & stillbirth Pre-eclampsia Preterm labour Diabetic retinopathy can rapidly worsen during pregnancy Macrosomia Perinatal mortality Postnatal fetal hypoG
What are the glucose targets for a woman with type1 diabetes wanting to conceive?
Fasting glucose: 5-7 on waking &
Plasma glucose 4-7 before meals
How is gestational diabetes diagnosed?
Oral Glucose Tolerance Test Usually 2nd trimester EITHER Fasting glucose >5.6 2hour plasma glucose >7.8
