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Domain 3 : Obstetrics > Pregnancy Induced Hypertension > Flashcards

Pregnancy Induced Hypertension Flashcards

1
Q

ESC: Incidence of PIH

A

5-10%

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2
Q

Maternal Risk factors

A

Placenta abruption
Stroke
Multi organ failure
DIC

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3
Q

Risk factors to the fetus

A

IUGR 25%
Prematurity 27%
IUFD 4%

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4
Q

Diagnosis: using blood pressure?

A

EBP > 140/90 or 160/110 severe

On 2 occasions >15min apart

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5
Q

ambulatory vs routine BP measurement

A

ambulatory BP monitoring is superior to routine BP measurement for the prediction of pregnancy outcome

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6
Q

Diagnosis: lab tests

A 
Urinalysis 
Blood count 
Hematocrit 
Serum creatinine 
Serum Uric acid
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7
Q

Diagnosis: urinalysis

A

Proteinuria
• > 1+ distick
• 24hr urine >30mg/mmol
• Albumin creat ratio >30mg/mmol >0.3

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8
Q

Diagnosis: ultrasound

A

Adrenals

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9
Q

Diagnosis: plasma

A

Metanephrine exclude pheochromocytoma

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10
Q

Diagnosis: Doppler

A

Uterine arteries @ 20 weeks

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11
Q

Diagnosis: markers

A

sFlt:PIGF (placentalgrowth factor) > 38

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12
Q

Definition of HPT

A

BP [systolicBP(SBP)>_140mmHg and/or DBP >_90mmHg]
mildly (140–159/ 90–109mmHg)or
severely (>_160/110mmHg) elevated BP

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13
Q

Classification of HPT in pregnancy

A 
Preexisting HPT 
Gestational 
Pre-eclampsia 
Preexisting HPT + superimposed gestational HPT  with proteinuria 
Antenatally unclassifiable HPT
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14
Q

Definition: pre-existing HPT

A

precedes pregnancy or develops before 20 weeks of gestation. It usually persists formore than 42days post-partum and maybe associated with proteinuria.

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15
Q

Definition: Gestational HPT

A

develops after 20weeks of gestation and usually resolves within 42 dayspost-partum.

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16
Q

Definition: Pre-eclampsia

A

gestational hypertension with significant proteinuria(>0.3g/24hor ACR >_30mg/mmol).
● It occurs more frequently during the first pregnancy,
• in multiple pregnancy,
• in hydatidi form mole,
• in antiphospholipid syndrome,or with
• preexisting hypertension,
• renal disease,
• diabetes. It is often associated with foetal growth restriction due toplacental insufficiency and is a common cause of prematurity.The only cure is delivery. As proteinuria maybe a late manifestation of preeclampsia,it should be suspected when denovo hypertension is accompanied by headache,visual disturbances, abdominal pain, or abnormal laboratory tests, specifically low platelets and/or abnormal liver function.

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17
Q

Definition: Antenatally unclassifiable hypertension

A

this term is used when BP is first recorded after 20weeks of gestation and hypertension is diagnosed; re-assessment i s necessary after 42days post-partum.

18
Q

Prevention/ prophylaxis for PIH

A

Aspirin 100-150mg/d from 12 weeks to 36/37

Calcium 1,5- 2g/day

19
Q

Which patients are at High risk of Pre-eclampsia?

A
  • hypertensive disease during a previous pregnancy
  • chronic kidney disease
  • autoimmune disease such as systemic lupus erythematosus or antiphospholipid syndrome
  • type1or type 2 diabetes
  • chronic hypertension.
20
Q

Moderate Risk of pre-eclampsia

A
  • first pregnancy
  • age 40 years or older
  • pregnancy interval of more than 10 years
  • BMI of >_35kg/m2 at first visit
  • family history of pre-eclampsia
  • multiple pregnancy.
21
Q

Can Vit C & E be used for Pre-eclampsia prevention/prophylaxis?

A

Both do not decrease pre-eclampsia risk;on the contrary, they are more frequently associated with a birth weight <2.5kg and adverse perinatal outcomes.

22
Q

Management of PIH: what non pharmacological interventions can be advised?

A

Regular exercise might be continued with caution and obese women (>_30kg/m2)are advised to avoid a weight gain of more than 6.8kg.

with randomized studies of dietary and lifestyle interventions showing minimal effects on pregnancy outcome.

23
Q

Pharmacological management : what level of HPT is an indications for admission?

A

SBP>_170mmHg or DBP>_110mmHg in a pregnant woman an emergency,and hospitalization is indicated

24
Q

Pharmacological management: severe HPT drugs

A 
Labetalol
Oral methylphenidate
Nifedipine
IV hydralazin  
Sodium nitroprusside last resort
25
Q

Pharmacological management:why is Sodium nitroprusside contraindicated in pregnancy?

A

increased risk of foetal cyanide poisoning.

26
Q

Pharmacological management: hydralazine

A

hydralazine is still commonly used when other treatment regimens have failed to achieve adequate BP control as most obstetricians find its side effect profile acceptable

27
Q

Pharmacological management: treatment of choice forPre-eclampsia with pulmonary edema

A

nitroglycerin (glyceryl trinitrate), given as an i.v. infusion of 5mcg/min,and gradually increased every 3–5min to a maximum doseof 100mcg/min.

28
Q

Management of mild- moderate PIH

A 
Methyldopa,
beta-blockers(most data available for labetalol),and
 calcium antagonists(most data available for nifedipine) are the drugs of choice
29
Q

B blockers in pregnancy

A

Beta-blockers appear to be less effective than calcium antagonists and may induce foetal bradycardia, growth retardation,and hypoglycaemia; consequently, their type and dose should be carefully selected,with atenolol best avoided.

30
Q

Drugs should be avoided

A

ACEI
ARBS
ARNI
Adverse foetal outcomes

31
Q

Diuretic in Pre-eclampsia

A

The plasma volume is reduced in pre-eclampsia, therefore diuretic therapy is best avoided unless in the context of oliguria,when low-dose furosemide maybe considered

32
Q

Magnesium sulfate

A

magnesium sulfate is recommended for the prevention of eclampsia and treatment of seizures, but should not be given concomitantly with CCBs(there is a risk of hypotension due to potential synergism).

33
Q

Magnesium sulfate regimens in pregnancy

A
34
Q

Delivery indications in PIH

A

Delivery is indicated in pre-eclampsia with visual disturbances or haemostatic disorders ,and at 37 weeks in asymptomatic women

35
Q

Prognosis after pregnancy in PIH: BP postpartum

A

Methyldopa should be avoided because of the risk of Postpartum depression

36
Q

Prognosis after pregnancy in PIH: HPT and lactation

A

•Breast feeding does not increase BP
•propranolol and nifedipine have breastmilk concentrations similar to those in maternal plasma.
Bromocriptine might be beneficial PPCM
Lactate suppression carbrgoline> bromocr

37
Q

Prognosis after pregnancy in PIH: recurr

A

High risk

38
Q

Prognosis after pregnancy in PIH: long term CVS consequences

A 
at increased risk of
hypertension,
stroke,and
ischaemic heart disease in later adult life.
Lifestyle modifications
39
Q

Recommendations for management of HPT

A
40
Q

Fetal monitoring for PIH

A
41
Q

Anaesthetic management :

A

Domain 3 : Obstetrics (30 decks)

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