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Obstetric Emergencies > Pre-eclampsia > Flashcards

Pre-eclampsia Flashcards

1
Q

How is hypertension in a woman identified?

A

systolic pressure is >140mmhG
and/or
diastolic pressure <90mmHg

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2
Q

how is mild hypertension in pregnancy identified?

A

systolic pressure 140-149mmHg
and/or
diastolic pressure 90-99mmHg

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3
Q

how is moderate hypertension in pregnancy identified?

A

systolic pressure 150-159mmHg
and/or
diastolic pressure 100-109mmHg

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4
Q

how is severe hypertension in pregnancy identified?

A

systolic pressure >160mmHg
and/or
diastolic pressure >100mmHg

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5
Q

after how many weeks is pre-eclampsia evident?

A

20

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6
Q

what are the risk factors for pre-eclampsia? name as many as you can (15)

A
  1. previous pre-eclampsia
  2. close family history of pre-eclampsia, renal or auto-immune disease
  3. chronic hypertension
  4. type 1 or 2 diabetes
  5. > 10 years between pregnancies
  6. nulliparity or primiparity
  7. age >40 years
  8. gestational hypertension
  9. BMI >35KG/m2 at first booking/visit
  10. multiple pregnancy
  11. previous IUD
  12. Previous placental abruption
  13. multigravida with new partner
  14. gestational trophoblastic disease
  15. fetal triploidy
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7
Q

what are the 5 organ systems associated involved with pre-eclampsia?

A
  1. neurological
  2. haematological
  3. hepatic
  4. renal
  5. placental
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8
Q

What are signs and symptoms of neurological involvement?

A
  • severe headache
  • persistant visual disturbances
    hyperreflexia with sustained clonus
  • seizures (eclampsia)
  • stroke (CVA)
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9
Q

What are signs and symptoms of haematological involvement?

A

damage to the blood vessel walls causing:

  • thrombocytopenia (decreased platelets)
  • haemolysis (breakdown of red blood cells leading to a reduction in clotting factors)
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10
Q

What are signs and symptoms of hepatic involvement?

A
  • epigastric pain
  • right upper quadrant pain
  • abnormal liver function tests
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11
Q

What are signs and symptoms of renal involvement?

A
  • proteinuria
  • oliguria <30mls per hour
  • elevated serum creatinine >90 umol/l
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12
Q

What are signs and symptoms of placental involvement?

A
  • decreased fetal movements
  • intra-uterine growth restriction
  • abnormal or non-reassuring fetal heart rate features
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13
Q

What is a normal amniotic fluid index (AFI) score and what score is concerning?

A

5-25cm is normal

<5 is concerning

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14
Q

What may the CTG show in a growth restricted or compromised fetus?

A
  • absent accelerations
  • decreased baseline variability and/or
  • shallow decelerations
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15
Q

what is chronic hypertension?

A

hypertension that is present before 20 weeks

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16
Q

what is gestational hypertension?

A

a new hypertension occurring after 20 weeks without significant proteinuria

17
Q

what is severe preeclampsia?

A

pre-eclampsia with severe hypertension and/or with symptoms and/or biochemical and/or haematological impairment

18
Q

What are the key factors in reducing morbidity and mortality associated with pre eclampsia? (6)

A
  1. identification, escalation and diagnosis
  2. monitoring blood pressure and treating hypertension
  3. monitor and managing maternal and fetal wellbeing
  4. managing the woman with pre eclampsia
  5. determining the optimal time for birth
  6. establishing a birth management plan
19
Q

signs and symptoms of pre eclampsia?

A
  • vomiting
  • visual disturbances/problems with vision
  • severe headache
  • severe pain just below the ribs
  • sudden swelling of the face. hands and feet
20
Q

what are the fetal indications to expedite birth include?

A
  • abnormal/non-reassuring fetal heart rate features
  • severe fetal growth restriction
  • absent or reverse arterial doppler flow studies
  • AFI <5
  • placental abruption
21
Q

what are 6 key factors in managing eclampsia?

A
  1. declare an emergency
  2. resuscitation (DRSABCD)
  3. minimising maternal and fetal hypoxia
  4. treating and preventing seizures
  5. controlling hypertension
  6. establishing a birth management plan
22
Q

what does DRSABCD stand for?

A 
Dangers
Responsiveness?
Send for help
open Airway
normal Breathing?
start CPR
attach Defibrillator
23
Q

what are the 3 categories of hypertension?

A

mild
moderate
severe

24
Q

what are signs and symptoms of eclampsia?

A
  • generalised seizures and jerking numb and head movement

- mother may become cyanosed, bite tongue or have urinary incontinence

25
Q

how long do seizures usually take to resolve?

A

90 seconds

26
Q

what is immediate management of eclampsia?

A
  1. maintain airway, breathing and circulation
  2. left lateral position
  3. protect from injury
  4. high flow oxygen via facemark
  5. do not attempt to retrain seizure
  6. maintain left lateral with open airway
  7. eclampsia box contains emergency equipment and medication
27
Q

how would you control seizures?

A
  • site 2 large bore cannulas
  • take blood for FBC, Us&Es, clotting and group and save
  • start treatment with magnesium sulphate
  • start intensive monitoring

Obstetric Emergencies (9 decks)

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