How is hypertension in a woman identified?
systolic pressure is >140mmhG
and/or
diastolic pressure <90mmHg
how is mild hypertension in pregnancy identified?
systolic pressure 140-149mmHg
and/or
diastolic pressure 90-99mmHg
how is moderate hypertension in pregnancy identified?
systolic pressure 150-159mmHg
and/or
diastolic pressure 100-109mmHg
how is severe hypertension in pregnancy identified?
systolic pressure >160mmHg
and/or
diastolic pressure >100mmHg
after how many weeks is pre-eclampsia evident?
20
what are the risk factors for pre-eclampsia? name as many as you can (15)
- previous pre-eclampsia
- close family history of pre-eclampsia, renal or auto-immune disease
- chronic hypertension
- type 1 or 2 diabetes
- > 10 years between pregnancies
- nulliparity or primiparity
- age >40 years
- gestational hypertension
- BMI >35KG/m2 at first booking/visit
- multiple pregnancy
- previous IUD
- Previous placental abruption
- multigravida with new partner
- gestational trophoblastic disease
- fetal triploidy
what are the 5 organ systems associated involved with pre-eclampsia?
- neurological
- haematological
- hepatic
- renal
- placental
What are signs and symptoms of neurological involvement?
- severe headache
- persistant visual disturbances
hyperreflexia with sustained clonus - seizures (eclampsia)
- stroke (CVA)
What are signs and symptoms of haematological involvement?
damage to the blood vessel walls causing:
- thrombocytopenia (decreased platelets)
- haemolysis (breakdown of red blood cells leading to a reduction in clotting factors)
What are signs and symptoms of hepatic involvement?
- epigastric pain
- right upper quadrant pain
- abnormal liver function tests
What are signs and symptoms of renal involvement?
- proteinuria
- oliguria <30mls per hour
- elevated serum creatinine >90 umol/l
What are signs and symptoms of placental involvement?
- decreased fetal movements
- intra-uterine growth restriction
- abnormal or non-reassuring fetal heart rate features
What is a normal amniotic fluid index (AFI) score and what score is concerning?
5-25cm is normal
<5 is concerning
What may the CTG show in a growth restricted or compromised fetus?
- absent accelerations
- decreased baseline variability and/or
- shallow decelerations
what is chronic hypertension?
hypertension that is present before 20 weeks
what is gestational hypertension?
a new hypertension occurring after 20 weeks without significant proteinuria
what is severe preeclampsia?
pre-eclampsia with severe hypertension and/or with symptoms and/or biochemical and/or haematological impairment
What are the key factors in reducing morbidity and mortality associated with pre eclampsia? (6)
- identification, escalation and diagnosis
- monitoring blood pressure and treating hypertension
- monitor and managing maternal and fetal wellbeing
- managing the woman with pre eclampsia
- determining the optimal time for birth
- establishing a birth management plan
signs and symptoms of pre eclampsia?
- vomiting
- visual disturbances/problems with vision
- severe headache
- severe pain just below the ribs
- sudden swelling of the face. hands and feet
what are the fetal indications to expedite birth include?
- abnormal/non-reassuring fetal heart rate features
- severe fetal growth restriction
- absent or reverse arterial doppler flow studies
- AFI <5
- placental abruption
what are 6 key factors in managing eclampsia?
- declare an emergency
- resuscitation (DRSABCD)
- minimising maternal and fetal hypoxia
- treating and preventing seizures
- controlling hypertension
- establishing a birth management plan
what does DRSABCD stand for?
Dangers Responsiveness? Send for help open Airway normal Breathing? start CPR attach Defibrillator
what are the 3 categories of hypertension?
mild
moderate
severe
what are signs and symptoms of eclampsia?
- generalised seizures and jerking numb and head movement
- mother may become cyanosed, bite tongue or have urinary incontinence
