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Phase 3a - Women's Health > Women's Health : Hypertensive Disease of Pregnancy > Flashcards

Women's Health : Hypertensive Disease of Pregnancy Flashcards

1
Q

What is PIH?

A

new-onset hypertension, developing after 20 weeks gestation.

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2
Q

What does PIH stand for?

A

Pregnancy-Induced HTN

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3
Q

When does PIH develop?

A

After 20 weeks gestation

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4
Q

What defines Pre-eclampsia?

A

new-onset hypertension associated with proteinuria or systemic features*, developing after 20 weeks gestation.

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5
Q

What causes PIH?

A

Systemic reaction to abnormally invasive placenta

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6
Q

Presentation of PIH?

A

asymptomatic, headaches, blurred vision

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7
Q

Presentation of Pre-Eclampsia?

A

asymptomatic, headaches, upper abdominal pain, blurred vision, reduced foetal movements // brisk reflexes, systemic hypertension

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8
Q

Initial investigation for Hypertensive disease in pregnancy?

A

BP + Urinanalysis + sFLT: PIGF ratio

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9
Q

What BP reading would indicate hypertensive disease in pregnancy?

A

140/90mmHg, +30/+15 in pre-existing hypertension

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10
Q

What Urinanalysis results would indicate hypertensive disease in pregnancy?

A

protein 2+ on dipstick, >30mg/mmol protein-creatinine ratio

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11
Q

What sFLT : PIGF ratio results would indicate hypertensive disease in pregnancy?

A

> 85 is diagnostic

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12
Q

Name further investigations for hypertensive disease in pregnancy?

A

Bloods, USS, Umbilical artery doppler velocimetry, cardiotocography, auscultation of foetal heart

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13
Q

Which Bloods are requested as part of further investigation of hypertensive disease in pregnancy?

A

FBC, U+E, LFT

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14
Q

How often are bloods requested as part of further investigation of hypertensive disease in pregnancy?

A

Twice weekly

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15
Q

What is the Ultrasound scan used for as part of further investigation of hypertensive disease in pregnancy?

A

To assess foetal growth and AFI

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16
Q

How often is an USS completed as part of further investigation of hypertensive disease in pregnancy?

A

2 weekly

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17
Q

What is the umbilical artery doppler velocimetry used for as part of further investigation of hypertensive disease in pregnancy?

A

assess placental perfusion

18
Q

How often is the umbilical artery doppler velocimetry done as part of further investigation of hypertensive disease in pregnancy?

A

2 weekly

19
Q

What is cardiotocography used for as part of further investigation of hypertensive disease in pregnancy?

A

upon diagnosis, + if RFM, PV bleed, abdo pain, deterioration

20
Q

How often is auscultation of foetal heart completed as part of further investigation of hypertensive disease in pregnancy?

A

offered at every appointment

21
Q

What is given for prevention of Hypertensive disease in pregnancy?

A

75mg aspirin OD from 12/40 onwards

22
Q

First Line treatment for Hypertensive disease in pregnancy

A

labetalol (beta blocker)

23
Q

Second Line treatment for Hypertensive disease in pregnancy

A

nifedipine

24
Q

Third Line treatment for Hypertensive disease in pregnancy

A

methyldopa

25
Q

For Hypertensive disease in pregnancy consider early delivery at…..

A

37 weeks

26
Q

Name some complications of Hypertensive disease in pregnancy

A

Eclampsia, HELLP syndrome, Placental Abruption, Disseminated intravascular coagulation

27
Q

What is HELLP syndrome?

A

syndrome of Haemolysis, Elevated Liver enzymes, Low Platelets

28
Q

Eclampsia symptoms

A

tonic-clonic seizures in presence of pre-eclampsia

29
Q

Management of Eclampsia

A

intravenous magnesium sulphate, emergency delivery via LSCS

30
Q

Management of HELLP syndrome

A

Intravenous magnesium, LSCS, plus expedite delivery

31
Q

What are the 3 diagnostic criteria of severe pre-eclampsia requiring urgent hospital admission?

A
  1. Systolic BP > 160 mmHg 2. Severe headaches, visual scotomate, N+V, oliguria, epigastric pain, pulmonary oedema 3. Rising Creatinine, elevated liver enzymes, thrombocytopenia
32
Q

What causes defective remodeling of maternal spiral arteries in pregnancy?

A

Inadequate invasion of extravillous trophoblast cells after week 10 leads to insufficient oxygenation of trophoblastic tissue and oxidative stress.

33
Q

How does oxidative stress affect the maternal body during pregnancy?

A

Oxidative stress causes stressed trophoblasts to release pro-inflammatory cytokines and other factors, including sFLT, into maternal circulation.

34
Q

What is the role of pro-inflammatory cytokines in pregnancy-related pathophysiology?

A

They disrupt maternal endothelium, causing systemic inflammatory response and reduced blood flow to maternal organs.

35
Q

How does hypertension develop in pregnancy due to defective spiral artery remodeling?

A

Impaired renal blood flow and reduced glomerular filtration, along with elevated sFLT (which binds to and impairs VEGF), contribute to hypertension.

36
Q

What causes proteinuria in pregnancy-related endothelial dysfunction?

A

Proteinuria results from glomerular changes, including disruption of the basement membrane and podocytes, though the exact mechanism is not fully understood.

37
Q

How does defective remodeling of maternal arteries impact fetal development?

A

It leads to placental hypoperfusion, which reduces nutrient delivery to the fetus, potentially causing intrauterine growth restriction (IUGR).

38
Q

What systemic effects arise from maternal endothelial dysfunction in pregnancy?

A

Endothelial dysfunction leads to vasodilatation and can affect maternal organs similarly to hypovolemic shock.

39
Q

Why do seizures occur in eclampsia?

A

Seizures in eclampsia are thought to occur due to cerebral vasospasm.

40
Q

What is the estimated worldwide incidence of pregnancy-related hypertensive disorders?

A

It is estimated to affect 4.6% of pregnancies globally.

41
Q

What are some risk factors for hypertensive disorders in pregnancy?

A

Risk factors include nulliparity, previous pre-eclampsia, family history, BMI >30, age >40, multiple pregnancy, and subfertility.

Phase 3a - Women's Health (21 decks)

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