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HMB2201 Complex Midwifery > Preeclampsia/HTN > Flashcards

Preeclampsia/HTN Flashcards

1
Q

What are the classifications of hypertensive conditions in pregnancy?

A
  • Chronic HTN
  • Gestational HTN
  • New proteinuria
  • Preeclampsia PE
  • Superimposed preeclampsia
  • Eclampsia
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2
Q

How is gestational HTN diagnosed?

A

Above 140/90 resting BP on at least 2 occasions within a week.
After 20 weeks.
Previously normotensive.
BP returns to normal 6-12 weeks PP.

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3
Q

What is new proteinuria?

A
  • Dipstick test shows 1+ on dipstick.
  • Random sample shows Protein:Creatinine ratio >30mg/mmol.
  • Urine protein excretion >300mg/24hrs.
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4
Q

What are the signs of preeclampsia?

A
  • new HTN (>140/90) with proteinuria (300mg/24hrs) after 20 weeks.
  • Headache, blurred vision, upper abdominal pain, altered biochemistry.
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5
Q

What is super-imposed PE?

A

When PE develops in a woman with existing HTN and/or proteinuria.

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6
Q

What are the signs of eclampsia?

A

Seizures during pregnancy and PP period.

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7
Q

What happens to the CVS with eclampsia?

A
  • Hypovolaemia
  • Haemoconcentration (increased cap permeability and reduced intravascular plasma vol.).
  • Pulmonary oedema (severe cases). This causes impaired oxygenation and cyanosis.
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8
Q

What happens when the clotting system is activated with eclampsia?

A
  • DIC (formation of fibrin clots and platelets trapped thrombocytopenia)
  • Fibrin and platelet deposition in vessels (occlusion of vessels and damage to major organs).
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9
Q

How does eclampsia effect the kidneys?

A
  • vasospasm of renal arterioles
  • decreased renal blood flow
  • glomerular capillaries damaged
  • plasma protein issues leading to proteinuria
  • When left untreated can lead to oliguria
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10
Q

How does eclampsia affect the liver?

A
  • Vasoconstriction of hepatic vascular bed leading to hypoxia and oedema of hepatic cells
  • Epigastric pain due to haemorrhage in the liver and, in rare cases, liver rupture.
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11
Q

How does eclampsia affect the brain?

A
  • increases permeability of the BBB leading to cerebral oedema and microhaemorrhages.
  • Autoregulation of cerebral flow is disrupted. This leads to cerebral vasospasm and oedema, blood clot formation (HTN encephalopathy).
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12
Q

How does eclampsia affect the fetoplacental unity?

A
  • reduces blood flow to uterus (placental abruption)
  • Reduced 02 for placental perfusion.
  • Ischaemic placental tissue leading to infarctions and IUGR.
  • Compromised hormonal output which leads to a compromised baby.
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13
Q

When is medication considered for chronic HTN?

A

If BP can not be kept <140/90

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14
Q

What is the management for chronic HTN?

A
  • close monitoring
  • normal diet with salt restriction
  • Advise regarding rest and weight control
  • Monitor fetal growth
  • IOL at 38 weeks or earlier if the BP rises.
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15
Q

When does a woman need to be admitted for chronic HTN?

A

> 160/100

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16
Q

What drugs are recommended for chronic HTN?

A
  • Vasodilator (Hydralazine)
  • Beta-blocker (labetalol)
  • Calcium channel blocker (Nifedipine)
17
Q

What are the complications regarding chronic HTN?

A
  • Increased likelihood of PE
  • placental abruption
  • renal failure
  • cerebral haemorrhage
  • IUGR
  • fetal hypoxia
18
Q

What is the management for PIH?

A
  • regular BP
  • USS to determine if hydatidiform mole is present.
  • FBE, electrolytes, urea
  • fetal growth surveillance
19
Q

PE is more common in women who are……..

A
  • primigravid
  • changed partners
  • those who have used barrier methods of contraception
20
Q

What are the predisposing factors of PE?

A
  • primi <19 or >40y
  • primipaternity
  • multiple pregnancies
  • hx of PE
  • family hx of PE
  • > 10yrs since last pregnancy
  • pre-existing conditions (DM, renal disease, obesity)
21
Q

How is PE classified?

A

Mild-mod
- BP >140/90 for 2 occurrences hours apart
- >20 weeks
Severe
- >160/110 for 2 occurrences hours apart.

Associated with proteinuria >300mg/24hrs and protein:creatinine ratio >30mg/mmol

22
Q

What are the S/S of PE?

A
  • fitting, hyperreflexia, clonus, visual changes, sever frontal headaches.
  • epigastric pain and vomiting
  • oedema
  • RFM
  • IUGR
  • elevated LFTs
  • reduced platelets
23
Q

PE effects what body systmes?

A
  • kidneys
  • liver
  • brain
  • lungs
  • vision
  • haematological
  • placenta
24
Q

What drugs are given for PE?

A
  • Antihypertensives (methyldopa and labetalol)
  • Steroids if <34 weeks
  • Celestone 11.4mg IM daily for 2 days
25
Q

How does the woman present with PE in the antenatal period?

A
  • BP uncontrolled
  • deterioration LFTs and/or RFTs
  • severe headaches and visual changes
  • Abruption (epigastric pain, N&V, signs of impending eclampsia)
26
Q

How does the fetus present with PE in the antenatal period?

A
  • IUGR
  • non-reassuring CTG
  • oligohydramnios

HMB2201 Complex Midwifery (8 decks)

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