Hypertension in Pregnancy

Question 1

commonest cause of iatrogenic prematurity?

Answer 1

pre-eclampsia

Question 2

there is vaso___ in pregnancy

Answer 2

dilatation

Question 3

what happens to BP post-natally?

Answer 3

goes down then reaches a peak at day 3/4 PN then settles back down around day 10

Question 4

what BP would indicate HT in pregnancy

Answer 4

> 140/90mmHg on 2 occasions

160/110mmHg once

Question 5

when would you assume a mother has pre-existing hypertension?

Answer 5

PMH
if they have high/upper normal BP in 1T
(PET is a disease of 2T+)

Question 6

Ix hypertension in pregnancy

Answer 6

ECHO
TFTs
renal USS
consider phaeo

Question 7

what is PIH? when does it occur and resolve?

Answer 7

pregnancy induced hypertension
second half of pregnancy
within 6 weeks of delivery

Question 8

how does PIH differ from PET?

Answer 8

don’t get proteinuria etc, only hypertension in PIH

Question 9

3 main symptoms of PET? do you need them all?

Answer 9

hypertension
proteinuria (>0.3g/l)
oedema
no

Question 10

pathophysiology of PET?

Answer 10

1. failed trophoblast invasion causes spiral arteries to the placenta to have low resistance
2. placental ischaemia = dec perfusion
3. maternal effect from this is endothelial dysfunction

Question 11

screening Ix antenatally for PET?

Answer 11

BP
urinalysis for protein
maternal uterine artery doppler USS

Question 12

what gestation marks the division between early and late pre-eclampsia

Answer 12

34 weeks

Question 13

majority of PET is early/late

Answer 13

late

Question 14

placental vascular and villous lesions are more common in early or late PET?

Answer 14

early

Question 15

effects of PET on CNS?

Answer 15

intracranial haemorrhage
cerebral oedema
cortical blindness
CN palsy
hypertensive encephalopathy
eclampsia

Question 16

symptoms of renal disease in PET?

Answer 16

proteinuria

oliguria

Question 17

symptoms of liver disease in PET?

Answer 17

RUQ pain

Question 18

symptoms of HELLP syndrome?

Answer 18

haemolysis
elevated liver enzymes
low platelets

Question 19

Ix liver disease in PET?

Answer 19

LFTs

Question 20

why do you get oedema in PET?

Answer 20

leaky BVs from endothelial dysfunction

Question 21

what happens to plasma volume in PET?

Answer 21

decreases

Question 22

resp complications of PET?

Answer 22

pulm oedema -> ARDS

PE

Question 23

complications of placental disease?

Answer 23

FGR

placental abruption

Question 24

symptoms of systemic PET?

Answer 24

headache
visual disturbance
epigastric/RUQ pain
N+V
rapidly progressive oedema
confusion

Question 25

signs of PET?

Answer 25

``` hypertension proteinuria oedema abdo tenderness disorientation SGA baby IUD hyperreflexia, involuntary movements, clonus (CNS issue) ```

Question 26

Ix PET

Answer 26

``` U+Es serum urate LFTs FBC coag screen - late sign urinalysis, if +ve urine PCR CTG - manages baby's HR, o2 sats USS - doppler, amniotic fluid index ```

Question 27

Tx PET

Answer 27

``` in hosp if PET, home if PIH treat HT surveillance steroids before delivery DELIVERY (weigh up risks and benefits) ```

Question 28

maternal risks for PET

Answer 28

``` age BMI FH para 1 multiple pregnancy previous PET large birth interval ```

Question 29

multiparous women have less severe PET

Answer 29

F, it is more severe and occurs earlier

Question 30

medical causes of PET

Answer 30

pre-existing renal or CT disease thrombophilia pre-existing HT diabetes

Question 31

when would you give PET prophylaxis? what dose?

Answer 31

low dose aspirin 75mg pd to high risk women before 12 weeks gestation

Question 32

what should you look at in a MUAD scan?

Answer 32

uterine artery iliac artery and vein NB uterine artery crosses the vessels

Question 33

indication on uterine artery doppler that suggests PET?

Answer 33

"bilateral notching" on MUAD

Question 34

when would you admit someone with PET?

Answer 34

``` BP >140/90 with proteinuria BP >170/110 systemic symptoms abnormal biochem severe proteinuria fetal compromise need antihypertensives ```

Question 35

when are BP, CTG and urinalysis done for PET inpatients?

Answer 35

BP every 4hrs CTG daily urinalysis daily

Question 36

1st line antihypertensive in pregnancy?

Answer 36

100mg labetalol

Question 37

contraindication to labetalol? what should be given?

Answer 37

asthma | nifedipine

Question 38

contraindication to methyl dopa? what kind of drug is it?

Answer 38

depression | alpha agonist

Question 39

what BP drug in pregnancy is contraindicated in breast feeding?

Answer 39

doxazosin

Question 40

what hypertensive drug classes are contraindicated in pregnancy?

Answer 40

ACEi | diuretics

Question 41

BP aim for PET patients?

Answer 41

140/90mmHg

Question 42

an MAP >___mmHg indicates a significant risk of.....

Answer 42

150 | cerebral haemorrhage

Question 43

what factors would make you sway more towards delivering the baby?

Answer 43

``` near term can't control BP eclampsia rapid deterioration fetal compromise - REDF, abnormal CTG ```

Question 44

define eclampsia

Answer 44

tonic clonic seizure in someone with features of PET

Question 45

eclampsia is more common at what age?

Answer 45

teenagers

Question 46

patients with eclampsia will always have PET symptoms before the seizure T or Fq

Answer 46

F, >1/3 will have seizure first

Question 47

Tx of eclampsia

Answer 47

``` fluid balance control BP IV labetalol, IV hydralazine MgSO4 IV for seizures delivery ```

Question 48

Tx of seizures in eclampsia

Answer 48

1. 1g MgSO4 IV 2. 2g MgSO4 IV 3. diazepam 10mg IV

Question 49

Ix suspected renal dysfunction from fluid overload

Answer 49

urine osmolality