Hypertension

Question 1

What percentage of pregnancies are affected by hypertension?

Answer 1

10-15%

Question 2

Define hypertension in pregnancy

Answer 2

> 140/90 on 2 occasions
160/110 once
30/15mmHg compared to first trimester BP

Question 3

Name three types of hypertension in pregnancy

Answer 3

Pre-existing
Pregnancy induced
Pre-eclampsia

Question 4

What are the secondary causes of hypertension in early pregnancy?

Answer 4

Renal 
Cardiac 
Cushing's 
Conn's 
Phaeochromocytoma

Question 5

What are the risk of pre-existing hypertension?

Answer 5

PET
IUGR
Abruption

Question 6

Describe pregnancy induced hypertension

Answer 6

Second half of pregnancy usually resolves within 6 weeks of delivery

Question 7

What is the triad of pre-eclampsia?

Answer 7

Hypertension
Proteinuria
Oedema

Question 8

Define pre-eclampsia

Answer 8

A pregnancy specific multi-system disorder with unpredictable variable and widespread manifestations

Question 9

Describe the pathogenesis of pre-eclampsia

Answer 9

Genetic and environmental factors

Cause defective deep placentation, the injured placenta releases factors into the maternal circulation

Question 10

State the two stages of pre-eclampsia

Answer 10

Stage 1 - abnormal placental perfusion (ischaemia)

Stage 2 - maternal syndrome

Question 11

What does abnormal placentation and trophoblast invasion do?

Answer 11

Failure of vascular remodelling

Question 12

What happens as a result of endothelial activation?

Answer 12

Increased capillary permeability
Increased expression of CAM
Increased prothrombotic factors, platelet aggregation and vasoconstriction

Question 13

What does HELLP stand for?

Answer 13

Haemolysis 
Elevated
Liver enzymes
Low
Platelets

Question 14

How does HELLP syndrome present?

Answer 14

Epigastric/RUQ pain
Abnormal enzymes
Hepatic capsule rupture

Question 15

What are the symptoms of pre-eclampsia?

Answer 15

Headache 
Visual disturbance 
Epigastric/RUQ pain 
Nausea, vomiting 
Rapidly progressive oedema

Question 16

What are the signs of pre-eclampsia?

Answer 16

Hypertension 
Proteinuria 
Oedema 
Abdominal tenderness 
Small for gestational age 
Intra-uterine foetal death 
Involuntary movements/clonus

Question 17

Name the investigations done in suspected pre-eclampsia

Answer 17

Urea and electrolytes 
Serum urate 
Liver function tests 
Full blood count 
Coagulation screen 
Urine-Protein Creatinine ration 
Cardiotocography 
Ultrasound

Question 18

How often should bloods be done in women with pre-eclampsia?

Answer 18

2 weekly

Question 19

How often should urinalysis be done in women with pre-eclampsia?

Answer 19

daily

Question 20

How often should BP be measured in women with pre-eclampsia?

Answer 20

4 hourly

Question 21

Name the risk factors for pre-eclampsia

Answer 21

Maternal age 
BMI 
Parity 
Previous PE 
Family History - hypertension, diabetes, APLS, autoimmune
Multiple/molar pregnancy 
Birth interval >10 years 
UTI

Question 22

What is the mode of action of aspirin?

Answer 22

Inhibits cycle-oxygenase to prevent TXA2 synthesis

Question 23

What is classed as high risk and what dose of aspirin is required?

Answer 23

Hypertension, CKD, autoimmune disease, diabetes

150mg daily 12-36 weeks

Question 24

What is classed as moderate risk and what dose of aspirin is required?

Answer 24

> 40 years old, BMI >35, family history, multiple pregnancy, first pregnancy, birth interval >10 years

Question 25

When should a women be admitted?

Answer 25

``` BP >170/110 or >140/90+proteinuria Significant symptoms Abnormal biochemistry Significant proteinuria >300mg/24 hours Requires anti-hypertensives Signs of fetal compromise ```

Question 26

At what MAP is there a risk of cerebral haemorrhage?

Answer 26

>150

Question 27

What is the BP aim?

Answer 27

140-150/90-100mmHg

Question 28

What BP requires immediate treatment?

Answer 28

>170/110

Question 29

Name the first line for hypertension in pregnancy

Answer 29

Methyl dopa - alpha agonist Labetolol - alpha and beta blocker Nifedipine - CCB

Question 30

Are there any contraindications for the first line hypertension treatment?

Answer 30

Methyl dopa - depression | Labetolol - asthma

Question 31

Name the second line hypertension drugs

Answer 31

Hydralazine - vasodilator | Doxazocin - alpha agonist

Question 32

What drug cannot be used while breast feeding?

Answer 32

Doxazocin

Question 33

What is the only cure to pre-eclampsia?

Answer 33

Delivery

Question 34

When is delivery indicated?

Answer 34

``` Inability to control BP Rapidly deteriorating Eclampsia crisis Fetal compromise Term gestation ```

Question 35

What is a pre-eclampsic crisis?

Answer 35

``` Eclampsia HELLP Pulmonary oedema Placental abruption DIC Cerebral haemorrhage Cortical blindness Acute renal failure Hepatic rupture ```

Question 36

What is eclampsia?

Answer 36

Tonic-clonic seizure with features of pre-eclampsia

Question 37

Which age group is eclampsia more common?

Answer 37

Teenagers

Question 38

What antihypertensives can be given in eclampsia?

Answer 38

IV labetolol | IV hydralazine

Question 39

What is given in eclamptic seizures?

Answer 39

Magnesium sulphate Diazepam if persistent Usually self limiting and will settle

Question 40

Describe the mechanism of action of magnesium suphate

Answer 40

Calcium channel blocker - improves foetal neurology in preterm labour

Question 41

Name two steroids that cross the placenta

Answer 41

Betamethasone | Dexamethasone

Question 42

How often do you given steroids in eclampsia and why?

Answer 42

IM corticosteroids 12-24 hours apart to help maturation of foetal lungs up to 34 weeks

Question 43

What do steroids reduce risk of?

Answer 43

``` Neonatal death Intraventricular haemorrhage Necrotising enterocolitis NICU/ICU admission Systemic infection ```