Women's Health : Hypertensive Disease of Pregnancy Flashcards
What is PIH?
new-onset hypertension, developing after 20 weeks gestation.
What does PIH stand for?
Pregnancy-Induced HTN
When does PIH develop?
After 20 weeks gestation
What defines Pre-eclampsia?
new-onset hypertension associated with proteinuria or systemic features*, developing after 20 weeks gestation.
What causes PIH?
Systemic reaction to abnormally invasive placenta
Presentation of PIH?
asymptomatic, headaches, blurred vision
Presentation of Pre-Eclampsia?
asymptomatic, headaches, upper abdominal pain, blurred vision, reduced foetal movements // brisk reflexes, systemic hypertension
Initial investigation for Hypertensive disease in pregnancy?
BP + Urinanalysis + sFLT: PIGF ratio
What BP reading would indicate hypertensive disease in pregnancy?
140/90mmHg, +30/+15 in pre-existing hypertension
What Urinanalysis results would indicate hypertensive disease in pregnancy?
protein 2+ on dipstick, >30mg/mmol protein-creatinine ratio
What sFLT : PIGF ratio results would indicate hypertensive disease in pregnancy?
> 85 is diagnostic
Name further investigations for hypertensive disease in pregnancy?
Bloods, USS, Umbilical artery doppler velocimetry, cardiotocography, auscultation of foetal heart
Which Bloods are requested as part of further investigation of hypertensive disease in pregnancy?
FBC, U+E, LFT
How often are bloods requested as part of further investigation of hypertensive disease in pregnancy?
Twice weekly
What is the Ultrasound scan used for as part of further investigation of hypertensive disease in pregnancy?
To assess foetal growth and AFI
How often is an USS completed as part of further investigation of hypertensive disease in pregnancy?
2 weekly
What is the umbilical artery doppler velocimetry used for as part of further investigation of hypertensive disease in pregnancy?
assess placental perfusion
How often is the umbilical artery doppler velocimetry done as part of further investigation of hypertensive disease in pregnancy?
2 weekly
What is cardiotocography used for as part of further investigation of hypertensive disease in pregnancy?
upon diagnosis, + if RFM, PV bleed, abdo pain, deterioration
How often is auscultation of foetal heart completed as part of further investigation of hypertensive disease in pregnancy?
offered at every appointment
What is given for prevention of Hypertensive disease in pregnancy?
75mg aspirin OD from 12/40 onwards
First Line treatment for Hypertensive disease in pregnancy
labetalol (beta blocker)
Second Line treatment for Hypertensive disease in pregnancy
nifedipine
Third Line treatment for Hypertensive disease in pregnancy
methyldopa
For Hypertensive disease in pregnancy consider early delivery at…..
37 weeks
Name some complications of Hypertensive disease in pregnancy
Eclampsia, HELLP syndrome, Placental Abruption, Disseminated intravascular coagulation
What is HELLP syndrome?
syndrome of Haemolysis, Elevated Liver enzymes, Low Platelets
Eclampsia symptoms
tonic-clonic seizures in presence of pre-eclampsia
Management of Eclampsia
intravenous magnesium sulphate, emergency delivery via LSCS
Management of HELLP syndrome
Intravenous magnesium, LSCS, plus expedite delivery
What are the 3 diagnostic criteria of severe pre-eclampsia requiring urgent hospital admission?
- Systolic BP > 160 mmHg 2. Severe headaches, visual scotomate, N+V, oliguria, epigastric pain, pulmonary oedema 3. Rising Creatinine, elevated liver enzymes, thrombocytopenia
What causes defective remodeling of maternal spiral arteries in pregnancy?
Inadequate invasion of extravillous trophoblast cells after week 10 leads to insufficient oxygenation of trophoblastic tissue and oxidative stress.
How does oxidative stress affect the maternal body during pregnancy?
Oxidative stress causes stressed trophoblasts to release pro-inflammatory cytokines and other factors, including sFLT, into maternal circulation.
What is the role of pro-inflammatory cytokines in pregnancy-related pathophysiology?
They disrupt maternal endothelium, causing systemic inflammatory response and reduced blood flow to maternal organs.
How does hypertension develop in pregnancy due to defective spiral artery remodeling?
Impaired renal blood flow and reduced glomerular filtration, along with elevated sFLT (which binds to and impairs VEGF), contribute to hypertension.
What causes proteinuria in pregnancy-related endothelial dysfunction?
Proteinuria results from glomerular changes, including disruption of the basement membrane and podocytes, though the exact mechanism is not fully understood.
How does defective remodeling of maternal arteries impact fetal development?
It leads to placental hypoperfusion, which reduces nutrient delivery to the fetus, potentially causing intrauterine growth restriction (IUGR).
What systemic effects arise from maternal endothelial dysfunction in pregnancy?
Endothelial dysfunction leads to vasodilatation and can affect maternal organs similarly to hypovolemic shock.
Why do seizures occur in eclampsia?
Seizures in eclampsia are thought to occur due to cerebral vasospasm.
What is the estimated worldwide incidence of pregnancy-related hypertensive disorders?
It is estimated to affect 4.6% of pregnancies globally.
What are some risk factors for hypertensive disorders in pregnancy?
Risk factors include nulliparity, previous pre-eclampsia, family history, BMI >30, age >40, multiple pregnancy, and subfertility.
