Pregnancy Complications

What percentage of pregnancies are affected by hypertension?

10-15%

What percentage of women who present with PIH develop pre-eclampsia?

15%

PIH and pre-eclampsia occurs during how many weeks gestation?

• commonly occurs between 24-28 weeks gestation

• can occur as early as 20 weeks

How long post delivery can pre-eclampsia present?

6 weeks

What BP is found in PIH?

140/90

What risk of developing pre-eclampsia with mild rises in BP is there beyond 37 weeks?

10%

Pre-eclampsia symptoms

• hypertension

• oedema

• proteinuria

What is one of the most dangerous complications in pregnancy?

eclampsia

What proportion of deliveries does eclampsia occur?

2.7:10,000

Pathophysiology of eclampsia

not fully understood

What is eclampsia?

a placental disorder associated with poor placental perfusion. often results in growth-restricted foetus

What sort of disorder is pre-eclampsia?

multi-organ disorder of pregnancy

When does pre-eclampsia develop?

after 20 weeks gestation, most commonly near term (37 weeks gestation)

What other times can pre-eclampsia develop?

can present or worsen in postnatal period (14 days following birth)

What is eclampsia?

generalised tonic clonic convulsion, progression of pre-eclampsia

When do women with eclampsia present?

• after 20 weeks gestation

• can also present first time during postnatal period usually 48hrs following birth

Neurological symptoms of pre-eclampsia

• headache

• visual disturbances

• flashing lights/blurring

• tremor

• confusion

• agitation/restless

GI symptoms of pre-eclampsia

• epigastric pain (mistaken for heartburn)

• URQ pain

• nausea/vomiting

• liguria

• PV bleed - signs of abruption

What should be done if pt has a convulsion and is >/= 20 wks gestation with hx of hypertension or pre-eclampsia?

treat for eclampsia

What should be done if pregnant pt has convulsion and has no hx of hypertension of pre-eclampsia and BP is normal?

treat for epilepsy

What proportion of maternities are affected by DKA?

6.3:100,000

When is DKA in pregnancy most common?

with type 1 diabetes, can affect those with T2 and gestational diabetes

What can DKA in pregnancy be provoked by?

• vomiting

• infections

• poor control of diabetes

• meds such as steroids

• insulin pump failure

• conditions such as gastroparesis

Signs and symptoms of DKA

• nausea, vomiting, abdo pain

• polyuria, polydipsia

• blurred vision, weakness, lethargy, altered mental status

• pear drop odour

• tachypnoea, tachycardia, hypotension, coma, shock

What is sepsis?

life threatening organ dysfunction caused by dysregulated response to infection

What happens during sepsis?

clinical syndrome where body’s immune system and coagulation systems are switched on by an infection

What is sepsis with shock characterised by?

life threatening condition:

• hypotension

• organ dysfunction/failure

Direct causes of sepsis

• pregnancy

• genital tract related

indirect causes of sepsis

• influenza

• covid

• group A and B strep

Signs and symptoms of sepsis in pregnancy

• fever/chills

• dizziness

• lower abdo pain

• foul smelling vaginal discharge

• vaginal bleeding

• increased HR

• discomfort or illness

Why is there increased susceptibility to infection in pregnancy?

reduced immunity

When should the sepsis screening tool for adults not be used?

• pregnant people

• of any gestation up to 4 weeks post birth, pregnancy loss or termination