5 - Obs - Hypertensive Disorders in Pregnancy - Pre-eclampsia

Question 1

Definition - ? disease unique to preg that usually manifests as ? of > ?/? after ? weeks with ? >?g/24h
-of ? origin and only cure is ?

Answer 1

multisystem
HTN 
140/90
20
proteinuria
0.3
placental
delivery

Question 2

Pathophysiology -
Blood vessel ? damage, due to exaggerated maternal ?
response, leads to ? , incr ?perm and ? dysfunction. These can affect all maternal ?
and accounts for all effects. Incr ? ? accounts for HTN, incr ? ? for proteinuria, reduced ?
BF for IUGR and reduced ?
perfusion for eclampsia.

Answer 2

endothelial
inflam
vasospasm
capillary
clotting
organs
vasc resistance
vasc perm
placental
cerebral

Question 3

Degree classification -
Mild - ? and mild-mod HTN (140-?/90-?)
Mod - ? and ? HTN (>?/?) with no maternal ?
Severe - ? and any HTN

Answer 3

proteinuria
159, 109
proteinuria
severe
160/110
complx
proteinuria
34 weeks
complx

Question 4

Epidemiology - approx ?% nulliparous women, approx ?% recurrence rate, up to 50% if ? preeclampsia before ?weeks

Answer 4

6
15
severe
28

Question 5

Aetiology + RF’s
- Predisposing RFs inc ?, prev/FHx of ?, ? inter-preg interval, obesity, extremes of maternal ? (esp >?), disorders characterized by ? disease (chronic ?, chronic ? disease, Sickle cell Disease, ??, autoimmune disease) and pregs w ? placenta (?, hydrops, ? preg).

Answer 5

nulliparity
preeclampsia
longer
age
>40
microvascular
HTN,
renal
DM
larger
twins
molar

Question 6

Clinical features -
Hx - usually ? , poss headache, ?, ? disturbance, ?+?, ? pain = late sign
Ex - ? found in most pregs but may be ?, not ? or sudden onset. Epigastric ? suggests impending ?.

Answer 6

aSx
drowsiness
visual
N+V
epigastric
oedema
massive
postural
tenderness
complx

Question 7

Complx of Pre-eclampsia

• Maternal - can cause death. - 7 complx
• Fetal - can cause death. - 4 complx

Answer 7

• HELLP, CVA, Eclampsia, Renal failure, Liver failure, Pulm oedema, Disseminated intravascular coagulation
• IUGR, Preterm birth, hypoxia, , placental abruption

Question 8

HELLP syndrome -

1) H = ? - ? urine, ? LDH, anaemia
2) EL = ??? - ? pain, ? failure, abnormal ?
3) LP = ?? - normally self limiting

can occur ?
Trt is ? and incl ? sulphate prophylaxis against ?

Answer 8

haemolysis
dark
raised
elevated liver enzymes
epigastric
liver
clotting
low platelets

postnatally
supportive
magnesium
eclampsia

Question 9

Eclampsia - trt with ?? and ? surveillance for other ?

CVA - trt ? > prevention

Renal Failure - ID by careful ? ? monitoring and ? measurement. ? in severe cases

Pulm oedema - ? preeclamptic pt v vulnerable to ??
trt = ? and ? - ? may dev - cause of mat mort.

Answer 9

mag sulph
intensive
complx

HTN

fluid balance
Cr
Haemodialysis

severe
fluid overload
O2
furosemide
ARDS

Question 10

Fetal complx -
? mort and morb of fetus are incr, pre-eclampsia accounts for 5% ? and 10% ? deliveries.
In pregs affected pre ?wks: principal prob is ?. ? delivery often req, though ? preterm labour more common.
At term: Pre-eclampsia affects fetal growth ? but is also ass w ? morb and mort. At all ? there is incr risk of ?abruption.

Answer 10

perinatal
stillbirths
preterm
34
IUGR
preterm
spont
less
incr
gestations
placental