pre-eclampsia Flashcards
what happens to uric acid
increases over 0.32
what happens to calcium in urine
hypocalciuria
BP in PE
over 140/90 where previously normal or increasing over pregnancy
Protein in PE
dipstick unreliable
P:Cr over 30 or over 300mg in 24 hours
platelets in PE
thrombocytopaenia
LFT in PE
transaminases elevated
role of calcium in PE prevention
In high risk women, can give 500mg QID from week 25= reduces risk of any cause of hypertension
but can mask pre-eclampsia and does not improve fetal outcomes
aspirin in PE prevention
Up to 75mg, start before 20 weeks
no increased bleeding
decreasedpre-eclampsia and preterm delivery rate in high risk pregnancies
What is the normal pattern of BP in pregnancy
Decreases, especially diastolic, until 20-24 weeks then increases towards pre-pregnancy values.
Define hypertension in pregnancy
Systolic over 140, diastolic over 90
of increase above booking readings of 30/15
Note you dont get pregnancy induced hypertension or pre-eclampsia before 20 weeks!
How do you tell the difference between Cardiac tamponade and constrictive pericarditis?
In cardiac tamponade there is characteristically no Y descent on the JVP (limited RV filling), pulsus paradoxus is present, Kussmaul’s sign is rare (compared with pericarditis- present).
Also look for pericardial calcification on CXR in constrictive pericarditis.
Poor prognosis in HOCM- markers (6)
Syncope FH SCD Young age at presentation nonsustained VT on holter monitor Abnormal BP changes on exercise Increased septal wall thickness
Cause of P/E?
Fetus produces antagonists of VEGF, TGF beta which lead to disruption of glomerulus and endothelial function
Risk factors
Past PE Nulliparous Age under 15 or over 35 diabetes obesity antiphospholipid syndrome multiple gestation renal disease chronic hypertension UTI!!! Mother or sister had it
treatment?
If severe –>deliver - IOL improves maternal outcomes, dont necessarily need LSCS
Aggressive BP management to reduce stroke- IV labetalol or hydralazine or nifedipine (good acute), prazocin
Methyldopa or oral labetalol ok if not acute
Concern that if you over treat hypertension, risk reduced fetal growth
Mg sulphate (?NMPA receptors in CNS) steroids for fetal lung maturation
Aim under 140/85 as per CHIPS study -
- no difference in fetal outcomes with tight vs less tight control ie growth restiction
- methyldopa superior to labetalol for PB control and PE- only subacute
- higher risk worse maternal outcomes in over 160/110
- lower risk severe maternal hypertension if target under 85 vs under 100
What does P/E mean for mum later?
increase vascular complications first 5 years
IHD, VTE, DM, CVA, ESRD
NOT CANCER
Risks with pregnancy if chronic essential hypertension?
increase risk P/E
increase risk IUGR
increase risk placental abruption
increase perinatal mortality
but no evidence that mild chronic hypertension treatment improves fetal outcomes
What BP meds ok in preg?
methyldopa
nifedipine
labetalol
What is gestational hypertension?
hypertension after 20 weeks that is NEW, without features to make it pre eclampsia
Risk recurrence PE?
Severe- 25%
regular- 15%
Do you get high BP in HELP?
NOT ALWAYS
What is the strongest risk factor?
APL syndrome
How can the uterine artery doppler study help?
In high risk women do at 20-24 weeks- if high resistance index, can suggest increase risk
How many times readings in order to diagnose hypertension in pregnancy?
Three times
