W2 - Hypertension in Pregnancy Flashcards
what does hypertension cause in pregnancy
preeclampsia
what complications does hypertension cause in pregnancy
reduced placental circulation
poor foetal development
what is preeclampsia associated with
older age
male foetus
familial but not genetic
what is the pathophysiology of preeclampsia
impaired trophoblast differentiation = poorly perfused placenta
what causes pre-eclampsia
abnormal trophoblast invasion
spiral arteries in placental bed - do not undergo normal vascular remodelling
what are some high risk factors of hypertension in pregnancy
CKD
Previous hypertension
diabetes
autoimmune - lupus
previous history
what is recommended if 1 of the high rissk factors are identified
Aspirin 150mg at night from 12 weeks until 36 weeks or delivery
what are some moderate risk factors for hypertension in pregnancy
first pregnancy
age over 40
high BMI
FHx
multiple pregnancy
what is recommended if someone has 2 or more moderate risk factors
Aspirin 150mg at night from 12 weeks until 36 weeks or delivery
why is there a cut off at 20 weeks
what are some signs and symptoms of preeclampsia
headache
N&V
placental abruption
visual disturbance
epigastric pain
foetal growth restriction
proteinuria
increased reflexes
oedema
what is HELLP syndrome
Haemolysis
Elevated Liver enzymes
Low Platelets
what are some maternal complications of pre-eclampsia
Eclampsia
HELLP syndrome
Intracranial haemorrhage
Placental abruption & DIC
Renal failure
Pulmonary Oedema
what are some foetal complications of pre-eclampsia
Intrauterine growth restriction
Oligohydramnios
Hypoxia from placental insufficiency
Placental abruption
Preterm birth
Intrauterine death
when should blood pressure be measured in pregnancy
every appointment
how should the blood presssure be measured at each antenatal appointment
Sitting Upright
Cuff at Level of Heart (Rt atrium)
Correct size of Cuff
Korotkoff V (disappearance)
diastolic cut-off
Nearest 2mmHg
NOT automatic - if so calibrated to pregnancy
what is the range for hypertension
140/90–159/109 mmHg
what is the blood pressure ranges for severe hypertension
160/110 mmHg or more
regardless of the threshold values what range of bp should also be measured
any rise from booking BP >30mmHg
if blood pressure high what blood test is done
PLGF- Placental Growth Factor testing
what is a normal range for PLGF
> 100pcg/ml
what is the range of an abnormal PLGF and what would this indicate
> 12 and<100
suggests placental dysfunction
what is the range of an highly abnormal PLGF and what would this indicate
<12
severe placental dysfunction risk of preterm labor
what is the first line drug for hypertension in pregnancy
labetalol
