ANC - Hypertensive disorders in pregnancy

Question 1

Def pre-existing HTN in pregnancy

Answer 1

> 140mmHg before pregnancy/<20W

Question 2

How does pre-existing HTN affect your risk of pre-eclampsia

Answer 2

6x incr risk

Question 3

Mx HTN in pregnancy (2)

Answer 3

1st line = lobetalol

Deliver 38-40w

Question 4

When is blood pressure lowest in pregnancy

Answer 4

2nd trimester

Question 5

Def pregnancy induced HTN

Answer 5

BP >140/90 >20w

Question 6

What are the 2 main causes of pregnancy induced HTN?

Answer 6

Pre-eclampsia

Transient HTN

Question 7

Def pre-eclampsia

Answer 7

Multisystem syndrome that = usually manifests as new HTN after 20w w/ signif proteinuria

Question 8

What is the only cure for pre-eclampsia

Answer 8

Delivery

Question 9

What are the 2 pre-eclampsia phenotypes?

Answer 9

Early onset

Late onset

Question 10

What is early onset pre-eclapmsia

Answer 10

Causing complications before 34w –> growth restriction

Question 11

What is late onset pre-eclampsia

Answer 11

> 34w + NOT assoc w/ growth restriction

Question 12

Pathophysiology - 1st step of pre-eclampsia - early onset

Answer 12

Incomplete trophoblastic invasion of spiral aaa –> decr placental perfusion

Question 13

Pathophysiology - 1st step pre-eclampsia - late onset

Answer 13

Intervillous perfusion reduces (has reached its limit)

B/c terminal are overcrowded + oxidative stress

Question 14

Pathophysiology - 2nd step pre-eclampsia

Answer 14

Placenta oversecretes proteins that regulate angiogenic balance
Widespread endothelial damage, vasoconstrictoin, clotting dysfunction

Question 15

% pre-eclampsia nulliparous F

Answer 15

6%

Question 16

% recurrence in prev pre-eclampsia mother

Answer 16

15%

Question 17

pt @ high risk pre-eclampsia (5)

Answer 17

HTN disease of preg
CKD
Autoimmune disease 
T1/2DM 
Chronic HTN

Question 18

pt @ moderate risk pre-eclampsia (6)

Answer 18

Nulliparous 
Age >40 
Pregnancy intervals >10y
BMI >35 @booking 
FHx pre-eclampsia 
Multiple pregnancy

Question 19

CF pre-eclampsia (6)

Answer 19

Usually asymp 
Headache
Drowsy
Visual disturbances
N+V
Epigastric pain

Question 20

O/E Pre-eclampsia (4)

Answer 20

HTN
Oedema - massive
Presence epigastric tenderness
Urine dip ++ proteins

Question 21

Maternal complications - pre-eclampsia (5)

Answer 21

can --> eclampsia --> grand mal seizures 
Cerebrovascular haemorrhage
Liver + coag problems (HELLP syndrome) 
Renal failure 
Pulmonary oedema

Question 22

Fetal complications of pre-eclampsia (4)

Answer 22

IUGR
Preterm birth
Placental abruption
Hypoxia

Question 23

Features of HELLP syndrome

Answer 23

H - Haemolysis (dark urine, raised LDH, anaemia)
EL - Elevated liver enzymes (epigastric pain, liver failure, abnorm clotting)
LP - Low platelets

Question 24

Ix pre-eclampsia (5)

Answer 24

Bedside urine dip 
PCR
Monitor maternal complications - FBC/U+E/LFT
USS
CTG + umbilical aa doppler

Question 25

Prevention pre-eclampsia

Answer 25

75mg aspirin before 16w to F at risk

Question 26

Drugs used in Mx pre-eclampsia

Answer 26

Nifedipine PO during preg 2nd line IV labetalol IV MGSO4

Question 27

Signs of MgSO4 toxicity (6)

Answer 27

``` Resp depression HOTN Hyporeflexia Somnolence Paralysis Cardiac arrest ```

Question 28

Mx pre-eclampsia <34w

Answer 28

CSC

Question 29

Mx pre-eclampsia >34w (8)

Answer 29

``` IOL (PG) Epidural can reduce BP CTG BP + monitored closely AntiH Avoid pushing in 2nd stage Oxytocin NOT ergometrine 3rd stage ```

Question 30

Post-natal care pre-eclampia (5)

Answer 30

``` LFT/platelets/renal fct monitored Fl balance monitored BP monitored - B blocker May req Tx for several w LT - comm w/ GP + Midwives ```

Question 31

Which LFT is always raised in pregnancy

Answer 31

ALP

Question 32

MgSO4 dosing in pre-eclampsia/eclampsia

Answer 32

4g IV MgSO4 stat | Then 1-2g/hr for 24h

Question 33

Fl restriction for pre-eclamptic F in labour

Answer 33

80ml/hr or 1ml/kg/hr

Question 34

Antidose MGSO4 toxicity

Answer 34

1g IV Calcium gluconate