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46 Cards in this Set
- Front
- Back
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Physiology
Effect of pregnancy on BP either .... or .....( placental circulation & vasodilator hormones) |
Effect of pregnancy on BP
either no change or slight drop ( placental circulation & vasodilator hormones) |
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Physiology
Effect of pregnancy on BP normal pregnancy does not lead to ....... |
normal pregnancy does not lead to elevation of BP
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Diagnosis of hypertension in pregnancy
Systolic > ... Diastolic > .... (better indicator) Note 1- measure BP at basal conditions 2- the high reading should be recorded at least twice 4 hours or more apart |
Systolic > 130 mmHg
Diastolic > 90 mmHg (better indicator) |
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Classification
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Chronic hypertension with pregnancy
Pregnancy induced hypertension |
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Chronic hypertension with pregnancy:
hypertension diagnosed...... or during ....... if the hypertension worsens in the second half of pregnancy it is called ...... |
- before pregnancy
-the first half of pregnancy -pregnancy aggravated hypertension. |
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Pregnancy induced hypertension:
hypertension diagnosed for the......, during ....... |
-first time after weeks of gestation
-labour and/or within 48 hours of delivery |
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Pre-eclampsia
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It is the presence of hypertension after 20 weeks of gestation (either pregnancy induced or aggravated) if it becomes complicated by proteinuria.
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Eclampsia
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It is pre-eclampsia complicated by convulsions
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Old Terminology
The triad of generalized edema, hypertension and proteinuria that develop in the second half of human pregnancy was known since a long time. Many names were used to describe it: |
-Toxaemia of pregnancy
-EPH gestosis -Pre-eclampsia -Pregnancy induced hypertension (PIH) |
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Pre-eclampsia
Although generalized edema is usually found, it is not included in the definition because it is not specific ( present in almost 50% of normal pregnant women at full-term) |
A syndrome which is unique to the second half of human pregnancy. It is characterized
by the development of hypertension and proteinuria. |
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Importance
If not detected early and managed properly it may lead to ..... It is one of the main causes of maternal ...... |
-several life threatening
complications -mortality worldwide. |
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Epidemiology
The general incidence about .... Higher incidence in: (high- risk group) |
-5%
- primigravida extremes of reproductive age vesicular mole multiple pregnancy hydramnios past or family history of pre-eclampsia pathological blood vessels e.g. DM |
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Aetiology
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unknown
disease of theories |
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disease of theories
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1. Immunological theory
2.Dominance of pressor PGs 3. Failure of trophoblastic invasion of spiral arterioles |
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Pathology
...... results in surrounding areas of haemorrhage & necrosis. The most affected organs are: ...... The ..... are specific for pre-eclampsia, (postmortum diagnosis). Rarely used for the diagnosis in the living subject. |
-Generalized vasoconstriction
-kidney, liver, placenta, brain &lung. -kidney changes |
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Clinical picture
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- generalized edema
- hypertension - proteinuria |
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Generalized edema
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Usually present
Not specific (present in 50% of pregnancies) It is caused by excess fluid retention It is usually the first clinical feature to appear |
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Generalized edema
Symptoms: Usually signs appear before symptoms |
- tightness of shoes & rings
- swelling of legs - puffiness of eyelids |
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Generalized edema
Signs: Usually signs appear before symptoms |
- rapid increase in body weight
- pitting lower limb edema - edema of face & abdominal wall |
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Hypertension
BP > .... Symptoms: ..... Usually the symptoms appear much later than detecting the elevated BP |
-130/90 mmHg
- headache blurring of vision |
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Proteinuria
Usually the..... of the 3 features to appear Its appearance signify a serious condition - increased risk of .... - increased risk of .... proteinuria has no symptoms or signs It can only be diagnosed by ..... |
- latest
-IUFD eclampsia -routine urine analysis during ANC visits |
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Proteinuria
Diagnosis: 1- protein in urine > .... 24 hour urine sample > ..... random urine sample 2- protein.... in test paper strips 3- .... of urine |
0.3 gm/L ,1 gm/L
> + (one positive) heating |
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Pre-eclamptic state (pre-eclampsism, impending clampsia)
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Very severe condition
Eclampsia will develop soon Emergency action has to be taken |
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Pre-eclamptic state
Manifestations: |
.Persistent hypertension > 200/120 mmHg
. Massive generalized edema . Heavy proteinuria . Oliguria or even anuria . Severe headache . Blurring of vision . Epigastric pain & tenderness . vomiting |
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Investigations
Fundus examination: .... |
present only in severe cases , reversible
- constriction of retinal arterioles - edema of optic disc - nicking of veins where crossed by arterioles |
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investigation
Blood tests: |
mostly non specific, only in severe cases
- elevated uric acid - elevated blood urea - elevated SGOT & SGPT - abnormal coagulation profile |
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investigation
Urine: |
- proteinuria
- oliguria |
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Complications
Maternal: |
1- eclampsia
2- complications of hypertension 3- DIC 4- HELLP syndrome |
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complications
Fetal: |
1- premature labour
2- IUGR 3- IUFD |
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Prediction
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Importance of prediction
Roll over test Doppler study of uterine arteries |
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Prevention
Pre-eclampsia cannot be prevented Possible role in prevention: ...... |
- more rest &sleep
- avoid excess salt & overeating - low dose aspirin |
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Symptoms usually appear much .... than signs
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Symptoms usually appear much later than signs
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Complications of pre-eclampsia can be
prevented by ....... |
Complications of pre-eclampsia can be
prevented by early detection (regular ANC) and control of the manifestations |
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Pregnancy induced hypertension management
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Home treatment allowed
rest Diet Sedation No diuretics Antihypertensives only if BP > 150/100 mm/Hg Follow up twice weekly ANC visits - weight - BP - proteinuria - extent of edema - signs of complications - fetal welbeing |
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General principles in management:
The only cure is by ....... If the fetus is mature ------------- ..... If the fetus is immature ---------- ..... |
-termination of pregnancy
-deliver -try to control - good control ---- wait till maturity & deliver - poor control or impending complications --- deliver immediately irrespective of maturity Delivery either by medical induction or elective CS |
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Pregnancy induced hypertension management
If BP is controlled (no more than ....):.... If BP is not controlled despite treatment or the fetus is compromised: ....... If proteinuria develops: ....... |
-150/100, continue same follow up till delivery
- deliver immediately irrespective of GA - manage as pre-eclampsia |
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Pre-eclampsia
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Hospitalization is a must
Absolute bed rest Diet fluid & semisolid food Sedation No diuretics Antihypertensives methyl dopa Strict observation of maternal & fetal parameters |
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Pre-eclampsia follow up
If BP is controlled, proteinuria not increasing, fetus not compromised: ....... If despite treatment for 48 hours, the BP is not controlled, proteinuria increases or fetal hypoxia starts to appear:...... |
-continue strict observation till full-term
-deliver immediately irrespective of GA |
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Pre-eclamptic state management
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-Admission in an ICU
-Absolute rest -Nothing/mouth IV fluids only -heavy sedation IV Diazepam -Antihypertensives IV methyl dopa -Magnesium sulphate IV drip infusion start with 4 gm then 4 gm every 4 hours |
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Pre-eclamptic state management
If the condition is controlled ,..... If the condition is not controlled within 24 hours, ..... |
-plan for delivery within 48 hours( good prognosis)
-emergency delivery is essential (guarded prognosis) |
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Important notice
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IN ALL THE 3 DEGREES THE PATIENT SHOULD BE UNDER SUPERVISION FOR THE FIRST 48 HOURS FOLLOWING DELIVERY BECAUSE COMPLICATIONS MAY APPEAR FOR THE FIRST TIME AT THIS TIME PERIOD
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Eclampsia
It is..... Incidence depends on ..... May develop ...... Cause is unknown; ? ..... |
- pre-eclampsia + convulsions (fits).
-level of antenatal care. -ante-partum (65%), intra-partum (20%) or post-partum (15%). -Cerebral hypoxia or cerebral edema. |
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Eclamptic fit
....... . Fits usually recur . |
-Premonitory stage few seconds
-Tonic stage few seconds -Clonic stage few minutes -Stage of coma minutes – hours |
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Eclamptic fit
DDx : ..... |
epileptic fits, meningitis, hysteria
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Prognosis of Eclamptic fit
Maternal mortality about... Perinatal mortality about .... Post-partum eclampsia has .... |
5%
30% the worst prognosis |
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Management of Eclamptic fit
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ICU admission
. Railed bed . Oxygen & suction . Guard against biting of tongue Mg sulphate Heavy sedation Plan delivery once fits are controlled |
