4: Hypertension in pregnancy

Question 1

Hypertension can ___ by pregnancy.

Answer 1

induced

due to cardiovascular changes in mother

Question 2

What is the spectrum of disorders caused by hypertension in pregnancy?

Answer 2

Pregnancy-induced hypertension > Pre-eclampsia > Eclampsia

Question 3

What is the fatal end-point of uncontrolled hypertension in pregnant women?

Answer 3

Eclampsia

Question 4

What percentage of pregnant women suffer from hypertension?

Answer 4

10 - 15%

Question 5

What cardiovascular changes occur in pregnancy?

Answer 5

HR, SV, contractility and CO INCREASE

BP and TPR DECREASE

Question 6

How does blood pressure change during the course of pregnancy?

Answer 6

Initially drops

Then increases gradually until term

Same pattern post-birth

Question 7

What blood pressure reading is required to diagnose a pregnant woman with hypertension?

Answer 7

> 140 / 90 on two occasions

> 160 / 110 once

Question 8

In which trimester does pregnancy-induced hypertension tend to develop?

Answer 8

2nd trimester

Question 9

If a pregnant woman develops hypertension before the 2nd trimester, what should you suspect?

Answer 9

Pre-existing hypertension

Question 10

What is the course of pregnancy-induced hypertension?

Answer 10

Persists throughout pregnancy, then resolves 6 weeks post-birth

Question 11

Does pregnancy-induced hypertension feature any other symptoms as in pre-eclampsia?

Answer 11

No

Question 12

What is the triad of signs seen in pre-eclampsia?

Answer 12

Hypertension

Proteinuria

Oedema

Question 13

What is pre-eclampsia?

Answer 13

A multi-system disorder developing in pregnant women and their foetuses due to widespread epithelial dysfunction

Presents as hypertension, proteinuria and oedema

Question 14

In which trimester of pregnancy does pre-eclampsia present?

Answer 14

2nd trimester

Question 15

What is the pathogenesis of pre-eclampsia?

Answer 15

Spiral arteries of placenta become compressed

Blood flow through tight arteries causes epithelial damage

Thrombosis –> Placental ischaemia

Toxins circulate throughout the body, causing widespread organ dysfunction

Question 16

Which process is blocked in pre-eclampsia, causing widespread damage?

Answer 16

Angiogenesis

Question 17

Why are toxins released from the placenta in pre-eclampsia?

Answer 17

Compression of spiral arteries causes endothelial damage, thrombosis and placenta ischaemia

Question 18

The toxins released by the placenta in pre-eclampsia damage the ___ of other systems.

Answer 18

vasculature

Question 19

What effects does pre-eclampsia have on the renal system?

Answer 19

Proteinuria

Reduced renal function (manifesting as decreased eGFR and urine output)

Question 20

What effect does eclampsia (untreated pre-eclampsia) have on the CNS?

Answer 20

Seizures

Cerebral oedema

Cranial nerve palsy

Coma

Question 21

What is a rare variant of pre-eclampsia caused by liver dysfunction?

Answer 21

HELLP syndrome

haemolysis, elevated liver enzymes, low platelets

Question 22

HELLP syndrome is a variant of pre-eclampsia caused by damage to which organ?

What are the signs?

Answer 22

Liver

Haemolysis, elevated liver enzymes, low platelets

Question 23

Where is pain felt in liver disease?

Answer 23

Epigastric region

Right upper quadrant

can refer to the right shoulder

Question 24

What are some respiratory complications of pre-eclampsia?

Answer 24

Pulmonary oedema

Pulmonary embolism

Question 25

The **signs** of pre-eclampsia are **hypertension, proteinuria and oedema.** What are the symptoms?

Answer 25

**Headache** **Visual disturbance** **Abdominal pain** **N&V** **Oedema**

Question 26

The foetus of a mother with untreated pre-eclampsia will be **(small / large) for dates**.

Answer 26

**small for dates**

Question 27

Does **eclampsia** present with **upper or lower motor neuron signs?** What are they?

Answer 27

**UMN signs** **Hyperreflexia, clonus** Followed by seizures and death

Question 28

Keeping in mind the **organs** which are damaged by pre-eclampsia, what **investigations** would you do for it?

Answer 28

**BP** **Renal function** - U&Es, eGFR, creatinine **Liver function tests** **Foetal** - ultrasound, CTG

Question 29

What specific ultrasound scan can be done for pre-eclampsia?

Answer 29

**Uterine artery doppler** Low flow and high resistance are signs of pre-eclampsia

Question 30

What is the only **definitive treatment** for pre-eclampsia?

Answer 30

**Delivery**

Question 31

If a baby has to be born pre-term, which drugs is the mother given to maximise chances of survival?

Answer 31

**Steroids** - speed up lung development **Magnesium** - neuroprotective

Question 32

In women with known pre-eclampsia, what is monitored at antenatal clinic visits?

Answer 32

**BP** **Renal function**

Question 33

Which drug is given in low doses to pregnant women with pre-eclampsia? Why?

Answer 33

**Aspirin** Prevention of thrombotic events

Question 34

If women fulfill the **risk factors** for pre-eclampsia before pregnancy, which drug should they be given?

Answer 34

**Low dose aspirin**

Question 35

Which **antihypertensive drugs** are pregnant women given in severe pre-eclampsia?

Answer 35

**Methyldopa** **Labetalol** **Nifedipine**

Question 36

Which drug classes, normally prescribed for hypertension, must be avoided in pregnancy?

Answer 36

**ACE inhibitors** **Diuretics** both cause adverse effects on foetus

Question 37

Name **three antihypertensives** prescribed for pre-eclampsia.

Answer 37

**Methyldopa** **Labetalol** **Nifedipine**

Question 38

What type of seizures are seen in **pre-eclampsia?**

Answer 38

**Tonic-clonic seizures**

Question 39

How is **blood pressure** controlled in **eclampsia**?

Answer 39

**IV antihypertensives** so **labetalol** or **hydralazine**

Question 40

Which drug is used to **prevent** or **terminate seizures** in **eclampsia?**

Answer 40

**Magnesium sulphate**

Question 41

What **side effect** of **spinal** or **epidural anaesthesia** is useful in patients with **eclampsia?**

Answer 41

**Widespread vasodilatation** --\> **Hypotension**

Question 42

Which **mode of delivery** is preferred in women with **(pre)eclampsia?**

Answer 42

**Vaginal delivery**