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Maternity > Week 4- hypertension in pregnancy > Flashcards

Week 4- hypertension in pregnancy Flashcards

1
Q

what are the CV changes during pregnancy?

A

Heart: rotates up and to the left 1-1.5 cm

Increased CO by 30 and 50%-

early pregnancy increased CO due to increased SV-pre load increased due to increased BP and afterload reduced due to decrease SVR

Late pregnancy0 increased CO due to increased HR

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2
Q

what is the timeline of CVS chages per trimester?

A

1- maternal systemic vasodilation]SVR progressivly drop 30/40%
CO begins to rise
HR begins to slowly rise

2- plataeu in SVR
CO continues to rise
HR increased

3- CO peaks in early third trimester 30-50% above baseline
HR peaks in late 3rd trimester - 16 bpm above non-pregnant values

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3
Q

what chages occur to the plasma volume during pregnanacy? why?

A

increases slowly from the third trimester, then expands rapidly from 30-34 weeks
this protects mum and baby, meets foetal nees, assists in perfusion and safegaurds agains blood loss at delivery

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4
Q

what are the changes to red blood cell mass during pregnancy? why?

A

begins to increase at 8 weeks and steadily rises

Supports higher metabolic requirment for oxygen during pregnancy
results in haemodilution causing anemia

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5
Q

what are the changes to BP in pregnancy?

A

Aterial BP decreases due to decreased Peripheral resistance
lowest in 2nd trimester- neraly normal by term

DEcreases diastolic by 10-15mmhg by 24 weeks

Systolic usually unchanged- decreases a max of 5-10 mmgh

pre-pregnant values return by thrid trimseter

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6
Q

what is supine hypotension in pregnancy?

A

supine position reduces CO, SV and increases HR
- due to compression of the aorta and inferior vena cava from the enlarging uterus

overcome by left lateral tilt to shift uterus off the aorta and IVC

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7
Q

what are the three clasifications of hypertension in pregnancy?

A

Chronic
non-proteinuric induced hypertension (gestational)
Pre-eclampsia- eclampisa and HELLP syndrome

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8
Q

what is the definition and risk factors for chronic hypertension?

A

Hypertension prior to pregnancy or increased BP above 140/90 before 20 weeks
Persistes up to 6 weeks post natal and may continue if pre-exisitng

Risk factors- renal diseas, diabetes, obestiy age >40 and HTN on the OCP

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9
Q

what is the definition and ris factors for gestational hypertension?

A

hpypertension >140/90 on >2 occasion
no other sings of pre-eclampsia
occures >20 wees

risk factors- primiparity/first child with new partner
obestiy, diabetes, preveious sevre pre-eclampsia, pre-existing CVD and age >40

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10
Q

what is the definition of pre-eclampsia?

A

Hypertension after 20 weeks plus any:

Renal, liver, heamotological or neurological involvment

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11
Q

what renal involvment may be seen with pre-eclampsia?

A

significant proteinuria- protien/creatinin ration >= to 30 mg/mol
Serum/plasma creatinin >90micromol/L
Oliguria: <80ml/4 hours

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12
Q

what liver involvement may be seen with pre-eclampsia?

A

abnormal LFTs

Sevre epigastric RUQ pain

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13
Q

what heamotological involevment may be seen with pre-eclampsia?

A

thrombocytopnia
heamolysis
DIC

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14
Q

what neurological involvment may be seen with pre-eclampsia?

A 
convulsions (eclampsia)
hyperflexia
new headache
visual disturbances
stroke
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15
Q

what are the risk factors for pre-eclampsia?

A 
First pregnanacy
multiparous witha hx of pre-eclampsia
pre0eclmapsia in previous pregnancy
10 years since last baby
>40 years old
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16
Q

what are the statistics for mild and sevre pre-eclampsia?

A

mild- 5-10 pregnancies

sevre- 1-2 %

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17
Q

what percenage of induced and c-section labours are due to pre-eclampsia?

A

20% induced

15% c-section

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18
Q

how many people die of eclampsia die world-wide annually?

A

50-75000

19
Q

What is the pathophysiology of pre-eclampsia?

A

Still unknown
abnormal placenta- with normal trophoblastic invasion of the spiral arteries inhibited- impeeding poetoplacental pressure system-leading to placental hypoxia

20
Q

what are trophoblasts and what do they do?

A

cells that develop into the placenta and provide nutrients to embryo- help to make spiral artiers less thick and more maliable which allow high flow and low pressure

21
Q

what occurs during phase one of pre-eclampsia?

A

insufficent/pathcy relase of trophoblasts causinf aprial artiers to uteroplacental remain ridged leading to high pressure and low flow.
the reduced flow leases to ishemia of the uteroplacntal spiral artiers

22
Q

what occurs during phase two of pre-eclampsia?

A

Inflmation and tress response due to ischemia

leading to endothelia dysfunction (leaky vessles), vasospasm and activation of the coagulation system: symptoms we see

23
Q

what are the pathological changes due to pre-eclampsia on the blood/cardiovascular system?

A

Hypertension with endothelia cell damage affecting capilary permiability
Plasma proteins leak- plasma colloid pressure drop and odeam

24
Q

what are the pathological changes due to pre-eclampsia on the coagulation system?

A

Altered coagulation cascade, increased platlet consuption- thrombocytopenia. DIC - Occlude kidneys: brain, liver and placenta

25
Q

what are the pathological changes due to pre-eclampsia on the kidneys?

A

Hypertension- vasospasm of afferent arteriols
decreased blood flow- hypoxia and odema of glmerulus allows plasma proteins to filter into urine
Oliguria a late sign

26
Q

what are the pathological changes due to pre-eclampsia on the brain?

A

Hypertension with CVS endothelia damage- increased blood-brain permiability- odeam and micro-heamorrage. Headaches and convuslions

27
Q

what are the pathological changes due to pre-eclampsia on the liver?

A

vasoconstriction- hypoxia and odeama
Epigastric pain and intracapsual heamorrage
decreased albumin and increased liver enzymes

28
Q

what are the pathological changes due to pre-eclampsia on the foeto-placental unit?

A

vasoconstriction and decreased blood flow
Vascular lesions can occur- abruption
Hypoxia and decreased foetal growth

29
Q

what is the presentation of pre-eclampsia?

A

Hypernesion and proteinuria and odeam

BP sharp rise >140/90 in second half pregnancy

Protenuria- complains decreased output

Odeama-
Sudden sevre- widespread- non-dependant areas eg face

Hyper-reflexia

30
Q

what are some other common complents for pts with pre-eclampsia?

A 
Frontal/occypital headaches
Blurred vision
epigastric pain
visual disturbances
nausea/vomitting
31
Q

When does pre-eclampsia occur?

A

Sudden or gradual onset
Often ditected in anti-natal care

Sudden onsest- usually in the third trimester, unwell for 2-3 days prior
Has not voided much, sudden weight gain and hypertension ++

32
Q

What is Eclampsia?

A

The presence of tonic-clonic seizures in the paitent that has pre-eclampsia

33
Q

What are some of the complications of pre-eclampsia?

A

Eclampsia, placental abrubtion, HELLP syndrome, blindness, intra uterine hypoxia

34
Q

What does HELLP syndrome stand for?

A 
Haemolysis
elevated
liver enzymes
low 
platlets
35
Q

What are the risk factors for HELLP syndrome?

A

Know-pre eclampsia
Multiparity
Previous HX

36
Q

WHat is commonly seen in HELLP syndrom paitents?

A

Mild hypertension
right upper quadrent pain
nausea and vomiting

37
Q

What are the phases of a seizure in eclampsia?

A

Premonitory- transiet and quick- eyes roll and muscle twitch

Tonic- 30 seconds- violet smasps, resps cease-cynosis

CLonic- last 2 mins
Jery muscular movments: froth blood stained siliva: stertuous breathing

Comatose- lasts few minutes to hours- deeply uncncious

38
Q

What histroy would we gather with the EPOMS numonic for pre-eclampsia?

A

Event- headache, abdo pain, weight gain, onset of symptoms

Pregnancy- A/N complcations, gestation

Obstertric - previous pregnancies/births, gradia/para: previous pre-eclampsia

Med Hx- fm hx, underlying conditions

SOcial- age, partner

39
Q

What might we find on examination of the pre-eclampsia pt?

A

BP >140/90

Asses for sings - odema, headache, visual disturbances, oliguria, epigastirc pain, hyer reflexia)

40
Q

What is the managment for pre-eclampsia?

A

Rest and reassurance
Position/lateral left
Oxygen- 8L via hudson- time critical transport

monitor for labour/ask about foetal movments
Transport!!- pre notification and what hospital, consult clinican/PIPER

41
Q

What do we have to look for in terms of deterioation in pre-eclampsia?

A 
Sharp rise in BP
frontal occypital headache
drowsiness/confusion
worsoning pain
naueas/vom
Pain/bleeding
42
Q

What is the managment for eclampsia?

A

Aiways- lateral position
100% o2
manage as per seizure guideline
transport

43
Q

What will happen in hospital in a paitent has eclampsia?

A

Blood tests, ultra sound, urine test- magment of hypertension
if disease is fumulating- requires immidiate lower uterine c section

Maternity (30 decks)

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