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Obs N Gynae > PIH > Flashcards

PIH Flashcards

(48 cards)

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1
Q

HTN in pregnancy

A

140/90 on 2 occasions 4 hrs apart

SBP-kortokoff sound 1
DBP- Kortokoff sound 5. ( N kortokoff sound 4 )

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2
Q

ACOG classification

A

Cat 1. Pre-eclampsia - Eclampsia syndrome
Cat 2 gestational HTN
Cat 3. Cronic HTN in pregnancy
Cat 4. Cr. HTN with superimposed pre eclampsia

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3
Q

Chronic HTN

A

Bp>/= 140/90. Before 20 weeks of gestation

Not come back to N after 12 w post delivary

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4
Q

PIH

A

POG > 20 w. Comes back to N within 12 w of delivery

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5
Q

Gestational HTN

A

PIH with no proteinuria or signs of end organ damage

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6
Q

Pre eclampsia

A

Proteinuria. ( non selective, only granular cast, not a/with red cell cast or nephritic or nephrotic syndrome &/or Signs of EOD

Dipstick test (screening). >/= +1
Urine protein creatinine ratio >/= 0.3
24 hr urine protein excretion ( gold std ) >/= 300mg

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7
Q

Signs of End Organ Damage

A
  1. Platelet count < 1 lakh
  2. Liver enz raised to 2 times + Epigastric Pain
  3. Serum creatinine >/= 1.1 mg/dl
  4. Pulmonary edema
  5. Visual Symptoms/ headache
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8
Q

Pre eclampsia classification

A

I. Early onset : 20-30 w
Preterm or late onset : 34 w - 37 w
Term onset : >37 w

II. PE without severe features (mild) : BP > 140/90 + no signs of impending eclampsia
PE with severe features (severe) : BP > 160/110 + signs of impending eclampsia + signs of EOD + GTCS

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9
Q

Signs of impending eclampsia

A

Headache ( not relieved by analgesics )
Epigastric pain
Visual symptoms

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10
Q

Eclampsia

A

New oneset of GTCS or coma in a pt. With pre-eclampsia

Types: Antepartum
Intrapartum ( during labour )
Postpartum ( within 48 hrs of delivery )

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11
Q

Cells regulating vascular remodelling

A

Maternal natural killer cell

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12
Q

Stages in PIH

A

I. Placental syndrome (stage 1) : AbN vascular remodelling, AbN placentation , Impaired trophoblastic differentiation/impaired pseudo vasculogenesis

II. Maternal syndrome (stage 2)

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13
Q

Effects of placental ischemia in PIH/PE

A
  1. Placenta : small size
  2. Fetus : IUGR, oliguria, oligohydroamnios
  3. Maternal : Increased BP
    Oedema
    Hemoconcentration
    Virchows triad ( endothelial enjury + stasis + hypercoagubility)
    Hematological changes- Thrombocytopenia, Microangiopathic hemolysis, Intravascular coagulation, Increased LDH levels
    MOD
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14
Q

MOD in mother with PE

A
  1. Kidney : Oliguria -> Increased serum creatinine + urea + uric acid
    Glomeruloendotheliosis
  2. Liver : Stretching of glissons capsule- Epigastric pain
    Periportal haemorrhage, vasospasm
    Hematoma formation
  3. Retina : Vasospasm
    Visual changes scotoma
    HTN retinopathy
    Retinal detachment
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15
Q

Factors increasing in PIH

A

SFLT-1
Endoglin
Thrombaxin A2

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16
Q

Factors decreased in PIH

A

VEGF
Placental growth factors
NO
Prostacyclin

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17
Q

Increased risk for PIH

A
  1. Nulliparous
  2. New paternity
  3. Long inter pregnancy interval
  4. Molar pregnancy
  5. Family history or SGA women
  6. Obese female (BMI>30)
  7. Age <18 >40
  8. Hydrops fetalis
  9. Pregnancy d/t ivf
  10. Use of barrier contraceptive before pregnancy
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18
Q

High Risk for PIH

A
  1. Previous h/o PE
  2. Chronic HTNive
  3. Multiple pregnancy
  4. Diabetic mother
  5. Female with kidney disease
  6. Female with immune disorder like APLA
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19
Q

Indication of Aspirin in PIH

A
  1. Any >/=1 high risk factors
  2. Any >/=2 of following factors
    i. Nulliparous
    ii. Age >35 yrs
    iii. Obese
    iv. Prior h/o LBW or IUGR
    v. Family h/o PE
    vi. Vulnarable sociodemographic factors
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20
Q

Aspirin dose time period

Study These Flashcards
A

Dose - 75-150 mg/day
Time period- <16 w (12-16 w). To 36 w

21
Q

Evaluation for raised bp

Study These Flashcards
A

I. Assess nature of disease
1. Proteinuria - urine dipstick, 24hr urine protein excretion, urine protein/creat ratio

  1. Urine microscopy- Red cell cast (chr. HTN), Granular cast(PE)

II. Assess severity
1. Platelet count
2. Liver enz
3. Serum creat.
4. LDH
5. Peripheral schistocytes

III. Assess fetal well being
1. NST
2. BPS
3. USG- for fetal growth, AFI, Doppler studies

22
Q

Top in case of
1. PE without severe features
2. PE with severe features
3. Chr HTN bt controlled
4. Chr. HTN with superimposed PE
5. On umbilical artery doppler :
S/D ratio increased >/= 3
Absent end diastolic flow
Reversal of end diastolic flow
6. Ductus venous doppler : absent a wave

Study These Flashcards
A
  1. > /= 37 w
  2. > /= 34 w
  3. 37-38+6/7d
  4. 37 w
  5. > /=37 w
    33-34 w
    30-32 w
  6. At 30 w
23
Q

Immediate TOP

Study These Flashcards
A
  1. Eclampsia or impending eclampsia
  2. HELP syndrome
  3. Fetal distress
  4. Abruption of placenta
  5. Uncontrolled HTN
  6. Progressive organ damage
24
Q

Management severe PE

Study These Flashcards
A

Measure- BP half hourly, Urine O/P hourly, Proteinuria 4hrly

Evaluate signs of impending eclampsia

Assess fetal well being

Drugs:
Anti hypertensive : Hydralazine iv Labetalol iv , Niedipine oral
MgSO4
Corticosteroid-28 to 34 w

> /=34 w & <28 w - Immediate delivery

25
Mgt of severe PE b/w 28 - 34 w
I. Delivery after first dose of corticosteroid 1. Impending eclampsia 2. Placenta abruptio 3. HELP syndrome 4. DIC 5. Pulmonary oedema 6. Fetal compromise 7. Uncontrolled severe HTN II. Delivery after 48 hrs of corticosteroid - PROM 1. PROM 2. Renal dysfunction/ fetal growth restriction 3. Oligohydromnios 4. Umbilical doppler- reversed diastolic flow III. Expectant Mgt
26
HELLP syndrome
Microangiopathic hemolysis Eevated liver enzymes Low platelet count
27
Presentation of HELLP
Sudden onset of pain (colicky) in abd at mid epigastrium or rt upper quad. Appears in3rd trimester Other: BP increase 85% cases Proteinuria
28
Diagnosis of HELLP syndrome
TENESSE criteria : H= Hemolysis +nt if any two seen: 1. Schistocytes or helmet cells or burr cells in peripheral smear 2. Increase in indirect bilirubin >/=1.2 3. Increase LDH >2 time (600 IU) & decrease heptoglobin (<25mg/dl) 3. Severe anemia unrelated to blood loss EL= Elevated Liver enzymes >2 times (70 IU) LP= Low platelet count (<1lakh)
29
D/d of HELLP syndrome
Acute Fatty liver of pregnancy
30
Mgt of HELLP synd
1. MgSO4 2. Anti hypertensive 3. Corticosteroids if <34 w 4. Definitive- TOP
31
Anti HTNive in severe PE first line
Hydralazine i.v Labetalol iv Nifedipine oral
32
Indication to start Anti HTNive
BP>/= 150/100 mmHg persistantly (4hrs apart) BP>/= 160/110 2 readings 15 min apart. (Hypertensive Crisis)
33
Other drugs for PE
Nitroglycerin Nitroprusside Nimodipine Nicardipine Veropamine Ketanserine
34
DOC for refractory HTN Its S/E
Na Nitroprusside Cyanide poisoning
35
Hydralazine dose S/E
Starting - 5mg im/iv 3 doses of 10 mg 15-20 mins apart Max dose = 30 mg S/E : Tachycardia, Hypotension, Headache, Palpitations
36
Labetalol dose S/E
10 mg -> 20 mg -> 80 mg Max - 220 mg S/E : Bradycardia, Hypotension, Asthma
37
Nifedipine dose. S/E
10 mg after 20 mins -> 20 mg 2 doses S(E : Tachycardia, Headaches
38
Anti HTNive in Chronic HTN 1. Indication 2. Target BP
1. BP>/=160/100 or co morbidities at lower BP 2. Generally: <150/100 In case or end organ damage like LVH or renal insufficiency : <140/90
39
1st line anti HTNive in chronic HTN
Labetalol oral Nifedipine oral Methyldopa oral
40
Other anti HTNive chronic HTN
Beta blocker : Propronalol, Metaprolol Ca channel blockers Diuretics
41
Anti HTNive absolutely C/I in pregnancy
ACE inhibitors Angiotensin receptor blocker - Losartan Diazoxide
42
Mechanism of action of MgSO4
Centrally acting drug Blocks NMDA receptors in brain CCB - membrane stabalisation Decrease release of acetylcholine Cerebral vasodilation High dose blocks peripheral calcium channels
43
Pritchard regimen
Loading dose : IM - 10 g, 50% solution (10 ampules) ;upper outer quad using 3 inch 30 guage needle IV - 4 g, 20% solution ( 4 ampules + 12 ml NS) ; over 10-15 mins Max infusion rate 1g/min Check maternal heart rate is giving high iv dose If seizures persist after 15 min repeat iv 2g in 20% solution Maintenance dose : 4 hourly till 24 hrs after delivery or last seizure whichever is last IM - 5 gm, 50% solution every 4hrly in alternate buttock Before giving check : 1. Knee jerk or patellar reflex intact 2. Urine O/P >/=100 ml in 4hrs 3. Respiratory rate >/= 12/min
44
MgSO4 toxicity 1. First sign @ 10mEq/L 2. 12mEq/L 3.@ 15mEq/L 4. @ >24 mEq/L 5. Other symptom
1. -nt Patellar reflex 2. Respiratory paralysis 3. Cardiac conduction defects 4. Cardiac arrest 5. Diaphoresis, Flushing, Slurring of speech
45
MgSO4 Toxicity Antidote
Calcium gluconate 1gm iv or CaCl2
46
ACOG recommendations for IV dose of MgSO4
Loading- 4-6 gm in 100 ml iv over 15-20 mins Maintenance: 1-2 gm/hr in 10 ml
47
Use of MgSO4 in obstetrics
1. DOC for neuroprotection in preterm labour- prevent CP in newborns 2. Prevention of seizures in impending PE, HELLP syndrome 3. Mgt of seizure in eclampsia
48
Mgt of Eclampsia
1. Airways mgt 2. MgSO4 3. Anti HTNive labetalol or Hydralazine 4. After stabalization TOP Mode of delivery - vaginal If delivary not within 24 hrs - Csection Anaesthesia- neuraxial

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