Pregnancy complications 2 Flashcards
Types of disorders (3)
Hypertensive disorders
Thrombosis
Diabetes
Hypertensive disorders in pregnancy - chronic hypertension
Hypertension either pre-pregnancy or at booking (≤ 20 weeks gestation
Values for hypertension , mild moderate and severe
Mild HT– Diastolic BP 90-99, Systolic BP 140-49
Moderate HT- Diastolic BP 100-109, Systolic BP 150-159
Severe HT- Diastolic BP ≥110, Systolic BP ≥ 160
Hypertensive disorders in pregnancy - what is gestational hypertension, when does it develop?
Gestational hypertension (PIH – pregnancy induced hypertension)
- BP as above but new hypertension (develops after 20 weeks)
Pre eclampsia is defined as?
they will have a headache - describe features
protein in urine level is greater than?
New hypertension > 20 weeks in association with
significant proteinuria
Mild HT on two occasions more than 4 hours apart
Moderate to severe HT
+ proteinuria of more than 300 mgms/ 24 hours (protein urine > +
protein:creatinine ratio > 30mgms/mmol)
Pathophysiology
Significant Proteinuria - reagent strip
Automated reagent strip urine protein estimation > 1+
Significant Proteinuria- Spot Urinary Protein
Creatinine Ratio > 30 mg/mmol
24 hour urine protein collection - significant score
> 300mg/ day
Essential/ Chronic hypertension
- more common in?
- patients should have?
older patients ie older mothers
- pre-pregnancy care
Change of antihypertensive drugs should be changed if indicated - how should you do this ?
Change anti-hypertensive drugs if indicated
eg. - ACE inhibitors (eg. Ramipril / Enalopril cause birth defects impaired growth)
- Angiotensin receptor blockers (eg losartan, Candesartan)
- anti diuretics
- lower dietary sodium
Aim to keep BP < 150/100 (labetolol, nifedipine, methyldopa)
Monitor for superimposed pre-eclampsia
Monitor fetal growth
May have a higher incidence of placental abruption
Where should you aim to keep blood pressure?
- what should you monitor for?
Aim to keep BP < 150/100 (labetolol, nifedipine, methyldopa)
Monitor for superimposed pre-eclampsia
Monitor fetal growth
May have a higher incidence of placental abruption
Pathophysiology of PET
- why does this happen (2)
- Immunological
- Genetic predisposition
- secondary invasion of maternal spiral arterioles by trophoblasts
impaired reduced placental perfusion - imbalance between vasodilators / vasoconstrictors in pregnancy
(prostocyclin / thromboxane
Risk factors for developing PET (lots to choose from )
First pregnancy Extremes of maternal age Pre-eclampsia in a previous pregnancy (esp. severe PET, delivery <34 weeks, IUGR baby, IUD, abruption) Pregnancy interval >10 years BMI > 35 Family history of PET Multiple pregnancy Underlying medical disorders - chronic hypertension - pre-existing renal disease - pre-existing diabetes - autoimmune disorders like – eg. antiphospholipid antibodies, SLE
PET is multi organ - systems affected are?
renal, liver, vascular, cerebral, pulmonary
Complications of PET? MATERNAL (6)
- eclampsia - seizures - severe hypertension
- cerebral haemorrhage, stroke
- HELLP (hemolysis, elevated liver enzymes, low platelets)
- DIC (disseminated intravascular coagulation)
- renal failure
- pulmonary odema, cardiac failure
Severe PET - SYMPTOM SIGNS
– headache, blurring of vision, epigastric pain, pain below ribs, vomiting,
sudden swelling of hands face legs
- Severe Hypertension; > 3+ of urine proteinuria
- clonus / brisk reflexes ; papillodema, epigastric tenderness
- reducing urine output
- convulsions (Eclampsia)