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Obstetrics and Gynaecology: Hypertension in Pregnancy
Terms in this set (64)
What is the commonest cause of iatrogenic prematurity?
In early pregnancy, blood pressure ________
In later pregnancy, blood pressure steadily _________
How is mild hypertension in pregnancy classified
How is severe hypertension in pregnancy classified?
How does ACOG classify hypertension in the second/third trimesters of pregnancy?
>30/15mmHg compared to the first trimester
How does severe hypertension affect a pregnancy?
Placental abruption; Foetal growth restriction; Cerebrovascular incident; pre-eclamptic toxaemia; Pre-term birth; Maternal and/or foetal death
What are the different types of hypertension in pregnancy?
Chronic hypertension; Gestational hypertension; Pre-eclampsia
In pre-existing hypertension in pregnancy, there can be primary (95%) or secondary causes. What are the likely secondary causes?
Kidney disease; Cushing's; Conn's; Phaeochromocytoma
When does pregnancy induced hypertension (PIH) typically take effect?
Second half of pregnancy
How quickly does PIH resolve after pregnancy?
How is PIH different from pre-eclampsia?
No proteinuria; Better prognosis
What can more severe PIH go on to become?
What may be the underlying cause of PIH?
Abnormal placental invasion of the myometrium with less uteroplacental perfusion
What are the chances of maternal and foetal complications with PIH?
What are the features of pre-eclampsia?
Hypertension; Proteinuria; Oedema
When does pre-eclampsia typically develop in pregnancy?
Second half of pregnancy
What are the potential complications as a result of pre-eclampsia?
Foetsl growth restriction; Prematurity; Eclampsia; HELLP syndrome; Disseminated intravascular coagulation; Maternal and foetal death
What is HELLP syndrome?
Haemolysis; elevated liver enzymes; low platelet count
What is HELLP syndrome associated with?
What causes pre-eclampsia?
Spiral arteries not fully invaded by trophoblasts; Maternal blood pressure increases to compensate for increases resistance; Endothelial damage from placental hypoperfusion causes proteinuria
What is eclampsia?
Onset of generalised seizures in a woman with pre-eclampsia
What causes eclampsia?
Loss of cerebral autoregulation leading to increased blood flow, vessel permeability and oedema
In patients with pre-eclampsia, there is often a genetic _____________
In severe pre-eclampsia, what is in the best interests of the mother?
What can be given to help mature the foetal lungs in severe pre-eclampsia that warrants expedited delivery?
How can pre-eclampsia affect the lungs?
Pulmonary oedema; Pulmonary embolus
How can pre-eclampsia affect the eyes?
Papilloedema; Retinal detachment; Cortical blindness
How does pre-eclampsia affect the haematological system?
Disseminated intravascular coagulation; Decreased plasma volume; Thrombocytopenia; Haemolysis; Haemoconcentration
What are the two stages associated with pre-eclampsia?
Abnormal placental perfusion and ischaemia; Anti-angiogenic state associated with endothelial dysfunction
What are the underlying reasons for endothelial dysfunction in pre-eclampsia?
SFlt1 and sEng antagonise VEGF and TGF-B which normally maintain endothelial health; There is an imbalance between angiogenic and antiangiogenic factors
Which CNS complications can pre-eclampsia lead to?
Eclampsia; Intracerebral haemorrhage; Oedema
As a result of pre-eclampsia associated renal disease, what substances increase in the body?
Serum uric acid; Creatinine; Potassium; Urea
How are the kidneys affected in pre-eclampsia?
Acute renal failure; Acute tubular necrosis; Renal cortical necrosis
How is the liver impacted in pre-eclamsia?
Hepatic failure; Hepatic capsule rupture; Abnormal LFTs; Abnormal liver enzymes
What are the associated symptoms of pre-eclampsia?
Headache; Visual disturbance; Epigastic/RUQ pain; Nausea and vomiting; Rapidly progressing oedema
Which neurological signs will be present in a patient with eclampsia/pre-eclampsia?
Generalised seizures; Hyper-reflexia; Involuntary movements; Clonus
Which tests will be undertaken in a patient with suspected pre-eclampsia?
Urea and electrolytes; Serum urate; LFTs; FBC; Coagulation screen; Urine PCR; CTG; USS
Which antenatal screening tests are applicable for hypertension?
BP; Urine; Maternal uterine artery doppler
What are the main risk factors associated with hypertension in pregnancy??
Maternal age >40; BMI >35; CKD; FH; Multiple pregnancy; History of previous; Birth interval >10 years; Diabetes; Multiparity; Molar pregnancy/triploidy; Autoimmune or connective tissue disease
What can be given to women at high risk of hypertension or pre-eclampsia in pregnancy?
75mg aspirin; Commence before 12 weeks
How can pre-eclampsia be detected in maternal uterine artery doppler?
Why does aspirin help with pre-eclampsia?
Inhibits production of thromboxane A2 which is a platelet-produced vasoconstrictor
On dipstick urinalysis, what indicates significant proteinuria?
What is the first line options for treatment of hypertension in pregnancy?
Besides labetolol, what other options are there as second/third lines for controlling hypertension in pregnancy?
Methyldopa; Nifedipine; Hydralazine; Doxazocin
What is the mechanism of action for labetalol?
Alpha and beta adrenergic antagonists
What is the mechanism of action for nifedipine?
Calcium receptor antagonist
What is the mechanism of action for hydralazine?
Vascualr smooth muscle relaxant
What is the mechanism of action for methyldopa?
Labetolol is avoided in patient with which condition?
What are the adverse effects of labetolol?
Bronchospasm; Neonatal hypoglycaemia
In an inpatient with pre-eclampsia, how often are blood tests done to check for HELLP syndrome?
In an inpatient with pre-eclampsia, how often is CTG done?
How is foetal surveillance achieved in a patient with pre-eclampsia?
Foetal movement; CTG; USS
In a patient with pre-eclampsia, an USS is done for foetal surveillance?
Biometry; Amniotic fluid index; Umbilical artery doppler
Most patients have seizures associated with eclampsia, before the onset of hypertension and proteinuria but some patients have them __________
Eclampsia is most common in which age group?
What are the management goals of severe hypertension in pregnancy or pre-eclampsia?
Control BP; Stop/prevent seizures; Fluid balance; Delivery
What is the treatment or prophylaxis for seizures in eclampsia?
If seizures are persistent in pre-eclampsia despite administration of magnesium sulphate, what may be considered?
What is the main cause of maternal death in pre-eclampsia?
Fluid balance; Pulmonary oedema
Why are fluid challenges in pre-eclampsia dangerous for the mother?
Already fluid overloaded
Why is ergometrine, a medication used to stimulate uterine contractions, avoided in patients with pre-eclampsia aiming for a vaginal delivery?
Side effect profile includes hypertension and seizures
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