Hypertension in pregnancy

Question 1

How does blood pressure change during pregnancy?

Answer 1

Fall in peripheral resistance causes BP to fall to nadir at 22-24 weeks; then rises steadily until term

Question 2

Risks associated with pre-existing hypertension in pregnancy (3)

Answer 2

Pre-eclampsia
IUGR
Abruption

Question 3

What is the triad of pre-eclampsia?

Answer 3

Hypertension
Proteinuria
Oedema

Question 4

What is proteinuria defined as?

Answer 4

> =0.3g/l or 0.3g/24hrs

Question 5

What is the underlying cause of pre-eclampsia? (3)

Answer 5

Abnormal placentation, leading to placental ischaemia and diffuse vascular endothelial dysfunction

Question 6

CNS manifestations of pre-eclampsia (5)

Answer 6

Eclampsia
Hypertensive encephalopathy
Haemorrhage
Cranial nerve palsy
Cortical blindness

Question 7

What does HELLP stand for?

Answer 7

Haemolysis, elevated liver enzymes, low platelets

Question 8

Blood disorders in pre-eclampsia (3)

Answer 8

Thrombocytopenia
Haemolysis
DIC

Question 9

Cardiorespiratory disorders (2)

Answer 9

Pulmonary oedema

P.E.

Question 10

Placental disorders (3)

Answer 10

IUGR
Abruption
Intra uterine death

Question 11

Symptoms of pre-eclampsia (5)

Answer 11

RUQ pain
Visual disturbance
Headache
Nausea/vomiting
Oedema

Question 12

Which test can be used to predict pre-eclampsia?

Answer 12

Maternal uterine artery doppler

Question 13

Risk factors for pre-eclampsia

Answer 13

Over age 40, high BMI, primigravid, previous pre-eclampsia

Question 14

Medical risk factors (5)

Answer 14

Renal disease, hypertension, diabetes, connective tissue disease, thrombophilia

Question 15

Drugs used to control hypertension and their class/mechanism (4)

Answer 15

Methyldopa (central alpha agonist)
Labetolol (alpha and beta antagonist)
Nifedipine (Calcium blocker)
Hydralazine (vasodilator)

Question 16

Contraindications to a) methyldopa b) labetolol

Answer 16

a) depression b) asthma

Question 17

When should steroids be given for best impact?

Answer 17

Up to 36 weeks gestation, 24-48 hours before delivery

Question 18

What dose of steroids is given?

Answer 18

2x 12mg betamethason IM given 12 hours apart

Question 19

What is the defining feature of eclampsia?

Answer 19

Tonic-clonic seizures

Question 20

How is hypertension in eclampsia managed and what is the risk?

Answer 20

IV hydralazine/labetalol. May cause fetal distress

Question 21

How are seizures managed/prevenetd?

Answer 21

Magnesium sulfate

Question 22

Which drug should be avoided in management of delivery in eclampsia and why?

Answer 22

Ergometrine. Can further increase the BP

Question 23

Secondary prevention of pre eclampsia

Answer 23

Low dose aspirin