L4 Hypertension, pre-eclampsia and gestational diabetes

Hypertension pre 20 weeks of gestation = ❌
Hypertension after 20 weeks:
1. BP above 140/90 = ❌
2. BP above 140/90, proteinuria and oedema = ❌
3. Preeclampsia with seizure = ❌

HELLP syndrome: A variant of severe pre-eclampsia. Elements include: H❌,
E❌ L❌ enzymes and
Low P❌ count.
In a woman with pre-eclampsia, the presence of any of the following is an indicator of HELLP:
• Maternal platelet count of ❌ x 10^9/L
• Elevated ❌ (twice normal concentration)
• Haemolytic ❌

Magnesium sulphate is an anticonvulsant used to prevent progression of preeclampsia to eclampsia.
It does not ❌ seizures but reduces ❌ of a further seizure.
Toxicity signs:
• Loss of patellar ❌
• ❌ paralysis
• Heart block
• Collapse of ❌ system
• Death
Antidote = calcium gluconate (10ml of 10% sln over 10 minutes)

Preeclampsia/eclampsia risks:
In the baby -
• Can decrease the supply of ❌ to the baby, this can result in reduced fetal growth
• Preterm birth
• Stillbirth, if placental ❌ (separation of the placenta from the uterine wall), leads to heavy bleeding in the mother
• Infant death
In the Mum -
• Stroke
• Seizure
• Pulmonary ❌
• Heart ❌
• Reversible ❌
• Bleeding from the liver
• Post-partum haemorrhage

Risks for gestational diabetes: Close family ❌ of type 2 diabetes, overweight, over ❌, if previous baby had ❌ or was large, previous stillbirth or miscarriage

Mechanism: placenta makes certain hormones that cause ❌. Mother needs to make ❌ more insulin, sometimes can't be done.

Symptoms: usually none, may be ❌ or tired, picked up during ❌ (antenatal blood tests include HbA1c) around ❌ weeks

Risks if untreated: needing C section, increased chance of HTN and ❌, fat baby, shoulder ❌ of baby during birth, ❌ baby after birth,