Hypertension in Pregnancy (Management)

Question 1

When should the risk of pre-eclampsia be assessed?

Answer 1

At booking

Question 2

If there is hypertension at < 20 weeks gestation, what should you do?

Answer 2

Look for an underlying cause

Question 3

What medication is used to try and prevent pre-eclampsia in high risk women? If a women is deemed to be high risk for pre-eclampsia, when should this be given?

Answer 3

Daily 75mg low dose aspirin, started by 12 weeks

Question 4

What is the function of aspirin?

Answer 4

Inhibit the cyclo-oxygenase enzyme which prevents TXA2 synthesis (a vasoconstrictor which is produced by platelets)

Question 5

What are some factors deemed high risk by NICE that would indicate use of low dose aspirin?

Answer 5

Previous hypertension in pregnancy or chronic hypertension, diabetes, autoimmune disease, CKD

Question 6

Where are chronic hypertension and mild-moderate gestational hypertension managed? Describe what is done?

Answer 6

In the community, BP is monitored as clinically indicated and proteinuria checked for at every antenatal appointment - if this develops then blood tests are repeated

Question 7

In cases of chronic pre-existing hypertension, when should ultrasound scans be used to monitor foetal growth and AFI?

Answer 7

28 and 32 weeks

Question 8

In cases of gestational pregnancy induced hypertension, when should ultrasound scans be used to monitor foetal growth and AFI?

Answer 8

At the time of diagnosis if < 34 weeks

Question 9

A MAP of over 150mmHg implies a significant risk of what?

Answer 9

Intracerebral haemorrhage

Question 10

BP in pregnancy is usually treated if over what value? A BP of over what requires immediate drug treatment?

Answer 10

150/100 / 170/110

Question 11

In pregnancy, you should be aiming for a blood pressure of what?

Answer 11

140-150/90-100mmHg

Question 12

What are some anti-hypertensives which are contraindicated in pregnancy?

Answer 12

Diuretics and ACE inhibitors

Question 13

What is the first line medication for hypertension in pregnancy? What is the mechanism of this drug?

Answer 13

Labetalol - alpha and beat adrenoceptor antagonist

Question 14

What is the second line PO medication for hypertension? What is the mechanism of this drug?

Answer 14

Nifidipine - Ca++ blocker

Question 15

What is the second line IV medication for hypertension? What is the mechanism of this drug?

Answer 15

Hydralazine - vasodilator

Question 16

What is the contraindication to the use of labetalol in pregnancy?

Answer 16

Asthma

Question 17

What are the contraindications to the use of methyldopa in pregnancy?

Answer 17

Depression, and the postnatal period

Question 18

What are all the drugs which can be used to manage hypertension in pregnancy?

Answer 18

Methyldopa, labetalol, nifidipine, hydralazine, doxazocin

Question 19

Which drug used to treat hypertension in pregnancy is not safe in breastfeeding?

Answer 19

Doxazocin

Question 20

What drug is given to stop and prevent seizures in eclampsia?

Answer 20

Magnesium sulphate

Question 21

What is the loading dose of magnesium sulphate?

Answer 21

4g IV over 5 mins

Question 22

What is the maintenance dose of magnesium sulphate?

Answer 22

1g/hour IV infusion

Question 23

If there are further eclamptic seizures following the first one, what is the management?

Answer 23

2g magnesium sulphate

Question 24

If seizures are persistent, what is the management?

Answer 24

10mg diazepam IV

Question 25

Does oliguria in pregnancy require intervention? If you have any doubts about a patients renal function, what should you do?

Answer 25

No / measure urine osmolality

Question 26

Fluid challenges in severe pre-eclampsia and eclampsia are dangerous - what should be done instead?

Answer 26

Run a patient dry - 80mls/hour

Question 27

What is the only definitive management of eclampsia?

Answer 27

Delivery

Question 28

If a woman is an inpatient as a result of hypertensive problems in pregnancy, how often should each of the following be done: a) BP? b) urinalysis? c) blood tests?

Answer 28

a) 4 hourly b) daily c) minimum twice weekly

Question 29

If there is proteinuria on urinalysis, what is the next best investigation?

Answer 29

Urine PCR

Question 30

Foetal growth and AFI are determined by US at diagnosis of pre-eclampsia, how often should they be repeated after this?

Answer 30

Every 2-4 weeks

Question 31

How often is cardiotocography done in women with pre-eclampsia?

Answer 31

Daily

Question 32

Ultrasound scans of mothers with pre-eclampsia are used to assess what?

Answer 32

Foetal growth, amniotic fluid index and umbilical artery Doppler

Question 33

If a woman with eclampsia is going to deliver her baby early - what is the most important thing to give?

Answer 33

2 doses of 12mg dexamethasone

Question 34

Most women with pre-eclampsia deliver within how long of diagnosis?

Answer 34

2 weeks

Question 35

For women with hypertension in pregnancy a delivery should be aimed for when?

Answer 35

37 weeks

Question 36

What are some indications for delivery in a woman with pre-eclampsia?

Answer 36

Term gestation, inability to control BP, rapidly deteriorating blood tests, eclampsia and other crises, foetal compromise

Question 37

What is the advantage to giving mothers with hypertension an epidural during labour?

Answer 37

It causes vasodilation which decreases BP

Question 38

What medication should be avoided at delivery in women with hypertension?

Answer 38

Ergometrine