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Flashcards in Hypertension in pregnancy Deck (24)
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1
Q

are there any changes to the ECG in pregnancy that are considered normal?

A

there are many

T wave inversion V1 - 3 can be normal.

small Q wave in lead III

2
Q

what happens to the following during pregnancy:

  1. CO
  2. SVR
  3. circ blood volume
A
  1. incr. CO
  2. dec. SVR
  3. circ blood volume inc
3
Q

What is the thing you listen to when checking someone’s BP? Which of the Korotkoff sounds?

A

systolic is I

diastolic is V, but if that’s silent, use IV

4
Q

what BP is considered hypertension in pregnancy?

what is considered SEVERE for urgent treatment?

A

> 140 / > 90

> 170/ >110

5
Q

if patient k < 20, and found to have HTN in the clinic, what is a good next test?

A

It seems that white coat hypertension is particularly common in k < 20 (where 1/3 will have normal ambulatory measurements)

therefore, consider amb BP in all k < 20

6
Q

what is the classification of gestational HTN, chronic HTN and PET?

A

gest is >140/90 after k 20

PET is gest plus organ involvement

chronic is >140/90 before k 20

7
Q

what is the definition of preeclampsia

A

hypertension after k 20

PLUS ONE OF:
proteinuria and renal insufficiency (PCR > 30; Cr > 90; oliguria)
liver disease (elevated AST ALT)
neuro problems (convulsions, hyperreflexia with sustained clonus, persistent headaches, visual abnor, stroke)
haematological disturbances (Plt < 100, DIC, haemolysis)
foetal growth restriction

8
Q

what are some factors that determine how severe a case of PET is?

A
if BP control is difficult
HELLP
impending eclampsia
worsening thrombocytopenia
worsening IUGR

the level of proteinuria is actually less important

9
Q

what is the underlying pathophys with PET?

A

for some reason there is less of the NKs and lymphocytes in the placenta. This means less cytokines being secreted.

Unfortunately there are less of these chemicals to stimulate the necessary changes in the spiral arteries. This means that these spiral arteries never become low-resistance enough for the placenta.

this leads to ischaemia

the ischaemic placenta also secretes a heap of factors:

sFLT-1 (soluble FMS like tyrosine kinase 1) - this mops up the PIGF, which leads to more procoagulant and vasoconstriction happening

syncytiotrophoblast microparticles (STMP) - inc. in PET, harmful to maternal endothelium

finally, there is endothelial cell dysfunction - this is from inc response to vasoactive substances like angiotensin II and reduced prostacyclin, NO

There is also systemic inflammatory response, with activation of neutrophils, monocytes, LLs with inc TNF, IL6, IL8

10
Q

risk factors for PET

A

Preconception Risk Factors

Partner related
Nulliparity; primipaternity
Limited sperm exposure
Previous PET pregnancy in partner

Maternal
Previous PET- 7X risk
FH PET- mother ~25% risk: sister 40% Increased age- > 40years – double risk Increased interval between pregnancies – 2-3 X if 10 years
Assisted reproduction

Underlying disorders
HT
Renal disease
Obesity – BMI > 30 double risk Diabetes mellitus Antiphospholipid syndrome
CT diseases

Pregnancy associated risk factors

Multiple pregnancies – 2-3X risk with twins
Congenital anomalies
Hydrops fetalis
Chromosomal anomalies
Hydatidiform mole
11
Q

what are the strongest RF for preeclampsia?

A

antiphospholipid

previous hx of PET
pre-existing DM

next three are equal:

  1. nulliparity
  2. multiple pregnancy
  3. fam hx of PET

then obesity (BMI > 30)

12
Q

what is the Tx of PET?

A

treat htn
monitor fluid balance

mag SO4 is useful for Tx of eclampsia and prophylaxis

give betamethasone for foetal lung maturation if gestation t deliver for 24 - 48 hours)

13
Q

what are the anti-HTN to use in pregnancy

A

commence anti HTN if systolic > 160 or diastolic >110

treatment options include

  1. labetalol IV 20 up to 80
  2. nifedipine oral 10 up to 40
  3. hydralazine IV 10 mg up to 30
  4. diazoxide 15 mg IV up to 45 mg
14
Q

why do we use magnesium in eclampsia?

A

the “collaborative eclampsia trial” published in Lancet in 1995 compared phenytoin, diaze, Mg in prevention of recurrent seizures and showed that mag was superior

15
Q

in a patient with pre-eclampsia, if you are proceeding to delivery, and the baby is significantly pre-term, are there any additional medications that are useful?

what role do those drugs have?

A

antenatal corticosteroids if

16
Q

are there any agents that can prevent preeclampsia in women with high risk?

A

aspirin (cochrane review 2007)
- give if mod-high risk and start prior to 20 weeks

calcium (cochrane 2006)
provide supplementation in patients with inc. risk of PET

17
Q

fact: most of the anti fungals are contraindicated in pregnancy

?maybe not amphotericin

A

fact: most of the anti fungals are contraindicated in pregnancy

?maybe not amphotericin

18
Q

what tests should you perform in a pregnant woman with hypertension at week 10?

A

ambulatory bp

ECG
urinalysis with PCR
catecholamines
renal uss
FBC
e/LFT
19
Q

what tests for pregnant woman with bp 150/100 at k30

A

fbc
e/lft
uric acid (is this based on fact?)

urine - PCR

USS for fetal growth, amniotic fluid, umbilical artery flow

coags?

20
Q

how much is intravasc volume expanded in preg?

how much is GFR inc in preg?

A

6L

50% for GFR

21
Q

when is the worst time in pregnancy for warfarin?

doxy?

lots of the others?

A

6 - 13 weeks

doxy - 12 - 40

8 - 12 weeks

22
Q

which of the street drugs is worst for preggos?

A

cocaine - causes placental vasoconstriction which is bad news

23
Q

women with microprolactinoma is on bromocriptine

she becomes pregnant

what do you do with bromocriptine?

A

it is a microprolactinoma which does not get bigger in pregnancy

therefore, stop the bromo

if it was a macro –> continue the bromo

24
Q

what happens to TSH, T3, T4 in pregnancy?

A

the TSH drops, because beta-hcg is a similar looking molecule and provides the same functional effect