6 Hypertension in Pregnancy

Question 1

List the 5 Hypertensions in pregnancy

Answer 1

1. Chronic or Essential hypertension
2. Gestational hypertension
3. Pre eclampsia
4. Eclampsia
5. HELLP Syndrome

Question 2

Chronic or essential is when there is high blood pressure discovered _____ to the pregnancy. Meaning that the pregnancy itself is not the cause.

Answer 2

prior

Question 3

The high blood pressure is found within the first ___ weeks of pregnancy.

Answer 3

20

Question 4

Secondary causes of the high BP include (3)

Answer 4

1. Renal disease
2. Endocrine disorders
3. Neurologic disorders

Question 5

What hypertension occurs after 20 weeks?

Answer 5

Gestational Hypertension

Question 6

Gestational hypertension is when the blood pressure is greater than __ occasions during pregnancy within __ hours of each other.

Answer 6

140/90 mmhg; 2; 6

Question 7

gestational hypertension high blood pressure is found after the ___ week mark. The patient did not exhibit high BP before this mark.

Answer 7

20

Question 8

With this type of hypertension there is no presence of protein in the urine and patients can be?

Answer 8

asymptomatic

Question 9

Often gestational hypertension resolves within the first ___weeks of giving birth

Answer 9

12 weeks.

Question 10

Patients with Gestational hypertension may have had high BP prior to the pregnancy and it may lead to

Answer 10

pre-eclampsia

Question 11

Pre-eclampsia is though to be caused by

Answer 11

Prostaglandin abnormalities

Question 12

Prostaglandins are a hormone like substance that participate in the following functions

Answer 12

Contraction and relaxation of smooth muscle
The dilation and constriction of blood vessels
control of blood pressure
modulation of inflammation

Question 13

Pe-eclampsia occurs when there is an abnormal development of

Answer 13

blood vessels of the placenta in early pregnancy

Question 14

With Pre-eclampsia oxygen supply to the fetus is?

Answer 14

reduced

Question 15

In pre-eclampsia the spiral arteries remain rigid instead of becoming large and

Answer 15

tortuous

Question 16

Pre-eclampsia occurs after __ weeks

Answer 16

20

Question 17

What is the cause of pre-eclampsia ?

Answer 17

the placenta

Question 18

When there is a decrease in oxygen to the placenta it releases inflamed molecules into the mothers blood stream and damages the

Answer 18

endothelial cells

Question 19

The S & S of pre-eclampsia include (4)

Answer 19

1. high BP 140/90mmHg after 20 week mark
2. Protenuria
3. Edema -swelling in the feet, hans and face
4. rapid weight gain

Question 20

In order for pre-eclampsia to be diagnosed

Answer 20

high blood pressure must be present with one of the other S&S.

Question 21

HELLP Syndrome stands for ?

Answer 21

Hemolysis - (destruction of red blood cells)
Elevated Liver enzymes - (ongoing liver damage)
Low Platelets - (help blood clot)

Question 22

A severe varient of pre-eclampsia

Answer 22

Abdominal pain due to hepatic hemorrhage

Question 23

Eclampsia occurs in women with severe

Answer 23

Pre-eclampsia

Question 24

Eclampsia is diagnosed when a women with pre-eclampsia has

Answer 24

seizures

Question 25

Aprox 30-50% of patients with pre-eclampsia also have the ___Syndrome

Answer 25

HELLP Syndrome

Question 26

Sonography in hypertension results in?

Answer 26

impaired circulation to the placenta

Question 27

Impaired circulation in the placenta results in (7)

Answer 27

``` IUGR Preterm labour Placental abruption Placental infarcts Oligohydramnios Decreased placental maturation Fetal demise ```

Question 28

What marker if low is considered a MARKER FOR PRE-ECLAMPSIA ?

Answer 28

PAPP A

Question 29

A maternal blood test is performed at the first trimester screen in conjunction with the

Answer 29

Nuchal translucency

Question 30

A repeat ultrasound is performed at ___ weeks with ____

Answer 30

23-24 weeks ;Doppler

Question 31

Artery Doppler is performed to look for (2)

Answer 31

1. Notching | 2. low diastolic blood

Question 32

Protocol for hypertension in pregnancy

Answer 32

1. BPP (for fetal well-being) 2. Growth (2nd or 3rd, Biometery) 3. Doppler of the umbilical artery

Question 33

Doppler - The umbilical artery normally is

Answer 33

LOW resistance

Question 34

Abnormal umbilical artery is High resistance artery is

Answer 34

Low or reversed diastolic flow

Question 35

What is the preferred method of measurement with umbilical artery doppler

Answer 35

Pulsatility index (PI)

Question 36

When there is restriction to placental blood flow a loss of _______ frequency occurs or it is reversed

Answer 36

end-diastolic

Question 37

THE MCA normally is

Answer 37

high resistance

Question 38

Low resistance has an increased _____ flow

Answer 38

diastolic

Question 39

When the MCA has impedence to blood flow the placenta has

Answer 39

low resistance

Question 40

When there is placental insufficiency the fetus adapts by

Answer 40

vasodilation

Question 41

With Hypoxia _____vasodilation occurs and once

Answer 41

cerebral

Question 42

Once vasodialtion from hypoxia is exhausted the diastolic flow will start to

Answer 42

increase

Question 43

The ______ can also be used as a screening tool

Answer 43

ductus venous

Question 44

The ductus venosus is the main vessel which ____ blood returning from the placenta is directed to the ____ and ____

Answer 44

oxygenated ; fetal heart and circulation

Question 45

In a normal fetus the ductus venosus demonstrates what appearance?

Answer 45

triphasic

Question 46

With worsening fetal hypoxia there is a redistribution of high oxygenated umbilical vein blood through the ductus venosus to the fetal heart . when critical an ____ in ____ and during atrial contraction there is ______flow

Answer 46

increase; Peak systolic forward flow ; retrograde

Question 47

Women with high risk of pre-eclampsia are screen using doppler indices for the _____

Answer 47

Uterine artery

Question 48

Abnormal indices of the uterine artery result from?

Answer 48

increase resistance to flow

Question 49

Often a ____ resistance waveform is associated with low change of pregnancy complications

Answer 49

low

Question 50

high resistance waveform with ____ present at the end of systole and reduced end diastolic frequencies are associated with higher rate of pregnancy complications

Answer 50

notching

Question 51

Notching in late pregnancy is an indicator of ?

Answer 51

increased uterine resistance and poor uterine circulation.

Question 52

Treatment for Hypertension

Answer 52

1. Bed rest 2. Medication 3. Monitoring mom and baby

Question 53

What is the only was to reverse the process?

Answer 53

Delivery

Question 54

Medication in pregnancy can cause (3)

Answer 54

fetal addition, IUGR and teratogenic defects