Hypertension in Pregnancy

Question 1

What is the commonest cause of iatrogenic prematurity?

Answer 1

pre-eclampsia

Question 2

When do most of the CVS changes in pregnnacy occur?

Answer 2

first trimester

Question 3

What is blood pressure proportional to?

Answer 3

systemic vascular resistance and cardiac output

Question 4

What happens to BP in the first trimester?

Answer 4

falls

Question 5

When does BP drop to its lowest in pregnnacy?

Answer 5

22-24 weeks

Question 6

What is normal BP in early pregnancy?

Answer 6

90-100/50-60

Question 7

When does BP return to normal post-partum?

Answer 7

6 weeks

Question 8

What is hypertension in pregnnacy defined as?

Answer 8

> =140/90 on 2 occasions; >160/110 once

Question 9

What are the 3 types of hypertension in pregnnacy?

Answer 9

pre-existing HT; pregnnacy induced HT; pre-eclampsia

Question 10

What makes pre-existing HT likely diagnosis in pregnnacy?

Answer 10

if HT in early pregnnacy

Question 11

When does PET and PIH tend to occur in pregnnacy?

Answer 11

second half f pregnnacy

Question 12

What are the risks of pre-existing HT in pregnancy?

Answer 12

PET; IUGR and abruption

Question 13

When does PIH resolve?

Answer 13

within 6/52 od delivery

Question 14

What is the typical triad of symptoms seen with pre-eclampsia?

Answer 14

HT; proteinuria; oedema

Question 15

What is proteinuria defined as?

Answer 15

> =0.3g/L or >=0.3g/24h

Question 16

What is pre-eclampsia?

Answer 16

diffuse casvular endothelial dysfunction with widespread circulatory disturbance

Question 17

What is early pre-eclampsia?

Answer 17

<34 weeks

Question 18

What is late pre-eclampsia?

Answer 18

> =34 weeks

Question 19

Is late or early pre-eclampsia more common?

Answer 19

late (almost 90%)

Question 20

What features of placental dysfunction are found in early pre-eclampsia?

Answer 20

extensive villous and vascular lesions of the placenta

Question 21

What is the difference between outcomes between early and late pre-eclampsia ?

Answer 21

early- higher risk of maternal and fetal complications but late has higher rates of eclampsia and maternal death

Question 22

Which type of pre-eclampsia does maternal factors such as HT and metabolic syndrome play a greater role?

Answer 22

late pre-eclampsia

Question 23

What is stage 1 of pre-eclampsia?

Answer 23

abnormal placental perfusion due to failure of trophoblastic invasion- placental ischaemia

Question 24

What is stage 2 of pre-eclampsia?

Answer 24

maternal syndrome- an anti-angiogenic state assoc. with endothelial dysfunction leading to organ involvement

Question 25

What causes the widespread endothelial dysfunction and damage in pre=eclampsia?

Answer 25

injured placenta releases toxins and high resistance of spiral artery causes maternal BP to rise to compensate

Question 26

What happens when endothelial cells are activated in pre-eclampsia?

Answer 26

increased capillary permeability; expression of CAM; prothromotic factors; platelet aggregation and vasoconstriction

Question 27

What do the cytotrophoblasts not do that causes the problems in pre-eclampsia?

Answer 27

do not invade the smooth muscle of the spiral artery so they still have high resistance

Question 28

What are the effects of pre-eclampsia on the CNS?

Answer 28

eclampsia; hypertensive encephalopathyl intracranial haemorrhage; cerebral oedema; cortical blindness; CN palsy

Question 29

What renal disease is seen with pre-eclampsia?

Answer 29

decreased GFR; proteinuria; increased serum uric acid; creat; K and urea; acute renal failure

Question 30

What liver disease is seen with pre-eclampsia?

Answer 30

epigastric/RUQ pain; abnormal liver enzymes; hepatic capusle rutpure; HELLP syndrome

Question 31

What is HELLP syndrome?

Answer 31

Haemolysis; elevated liver enzymes and low platelets

Question 32

What haematological disease is seen in pre-eclampsia?

Answer 32

decreased plasma volume; thrombocytopenia; haemolysis; disseminated intravascular coagulation

Question 33

What causes pulmonary oedema in pre-eclampsia?

Answer 33

iatrogenic- fluid overloaded

Question 34

What can pulmonary oedema lead to?

Answer 34

ARDS

Question 35

What placental disease is seen with pre-eclampsia?

Answer 35

IUGR; placental abruption; IUD

Question 36

What are the symptoms of pre-eclampsia?

Answer 36

HA: visual disturbance; epigastric/ RUQ pain; N and V; rapidly prgressive oedema

Question 37

What are the signs of pre-eclampsia?

Answer 37

HT; proteinuria; oedema; abdo tenderness; disorientation; SGA; IUD; hyper-reflexia/ involuntary movements/ clonus

Question 38

What blood level is often the first thing to be elevated in pre-eclampsia?

Answer 38

serum urate

Question 39

What investigations should be done for pre-eclampsia?

Answer 39

U&Es; serum urate; LFTs; FBC; coag screen; urine PCR; CTG and US

Question 40

What shoudl be done if a woman has HT <20 weeks?

Answer 40

look for secondary causes

Question 41

What are hte risk factors for developing pre-eclampsia?

Answer 41

>40 yo; >30 BMI; FHx; nulliparity; multiple pregnnacy; previous PE; birth interval >10 years; molar pregnancy;

Question 42

What are the medical risk factors for devleoping pre-eclampsia?

Answer 42

renal disease; HT; diabetes; connective tissue disease; thrombophilias

Question 43

When should low dose aspirin be given for preventing PET?

Answer 43

high risk women- renal DM; APS; multiple risk factors prev PET

Question 44

When should low dose aspirin as a preventative be started?

Answer 44

before 12 weeks

Question 45

What measurement on USS is used to predict pre-eclampsia?

Answer 45

maternal uterine artery doppler

Question 46

When is MUAD done?

Answer 46

20-24 weeks

Question 47

When should a woman be admitted with hypertension?

Answer 47

BP >170/110 OR >140/90 with ++proteinuria; sgnif symptoms ; abnormal biochemistry; signif proteinurai; need for antihypertensive therapy; signs of fetal compromise

Question 48

How often should BP done as an inpatient?

Answer 48

4hrly

Question 49

How often should UA be done as an inpatient?

Answer 49

daily

Question 50

What is there a great risk of if MAP >=150

Answer 50

cerebral haemorrhage

Question 51

What is the MOA of methyldopa?

Answer 51

centrally acting alpha agonist

Question 52

What is the CI for methyldopa?

Answer 52

depression

Question 53

What is the MOA of labetolol?

Answer 53

alpha and beta antagnoist

Question 54

What is the CI for labetolol?

Answer 54

asthma

Question 55

What is the MOA of nifedipine?

Answer 55

Ca channel antagonist

Question 56

What is the MOA of hydralazine?

Answer 56

vasdilator

Question 57

What is the MOA of doxazocin?

Answer 57

alpha antagonist

Question 58

When should doxazocin not be used?

Answer 58

in breast feeding

Question 59

What is the only cure for pre-eclampsia?

Answer 59

birth

Question 60

What are the indications for birth with pre-eclampsia?

Answer 60

term gestation; inability to control BP; rapidly deteriorating biochem; eclampsia; featl compromise

Question 61

What are the crises in pre-eclampsia?

Answer 61

eclampsia; HELLP syndrome; po oedema; placental abruption; cerebral haemorrhage; cortical blindness; DIC; acute renal failures; hepatic rupture

Question 62

What is eclampsia?

Answer 62

tonic-clonic seizure occuring with features of pre-eclampsia

Question 63

Why is eclampsia difficult to prevent?

Answer 63

>1/3rd will have seizure before onset of HT/proteinuria

Question 64

What age group is eclampsia more common in?

Answer 64

teens

Question 65

What drug is used as seizure tx/prophylaxis?

Answer 65

magnesium sulphate

Question 66

What drug should be used with persistent seizures?

Answer 66

diazepam

Question 67

Why should epidural anaesthesia be recommended in pre-eclampsia/ eclampsia?

Answer 67

hypotension and relaxes patient

Question 68

What drug should be avoided during the 3rd atge with eclampsia?

Answer 68

ergometrin