Hypertensive Disease In Pregnancy

Question 1

Overall Rate of preeclampsia

Answer 1

3-5%

Question 2

Incidence of eclampsia

Answer 2

27.5 per 10000 maternities

Question 3

Eclampsia rate in patients with preeclampsia

Answer 3

1%

Question 4

Chronic hypertension with superimposed preeclampsia

Answer 4

25%

Question 5

Risk of preeclampsia if mother had preeclampsia

Answer 5

20-25%

Question 6

Risk of preeclampsia if sister has preeclampsia

Answer 6

35-40%

Question 7

Risk of recurrent pregnancy induced hypertension

Answer 7

11-15%

Question 8

PIH in current pregnancy..
Risk of preeclampsia in future ?

Answer 8

7%

Question 9

Preeclampsia in current pregnancy…
Risk of PIH in future

Answer 9

13-53%

Question 10

Risk of recurrent preeclampsia if delivery <34 weeks due to severe pe, hellp syndrome or eclampsia

Answer 10

25%

Question 11

Risk if recurrent preeclampsia if delivery 34-37 weeks

Answer 11

23%

Question 12

PIH developing CHTN

Answer 12

3%

Question 13

Preeclampsia risk of :
Cardiovascular event

Answer 13

1.5-3 fold

Question 14

Pre eclampsia risk of
Cardiovascular death

Answer 14

2 fold

Question 15

Pre eclampsia risk of
Stroke

Answer 15

2-3 fold

Question 16

Pre eclampsia risk of
Developing HTN

Answer 16

2-5 fold

Question 17

PIH risk
Cardiovascular event

Answer 17

1.5-3 fold

Question 18

PIH risk
Developing HTN

Answer 18

2-4 fold

Question 19

High risk factors for developing pre eclampsia (5)

Answer 19

• CKD
• Preexisting Diabetes
• Chronic HTN
• Previous preeclampsia
• Autoimmune disease

Question 20

Moderate risk factors of developing pre eclampsia (6)

Answer 20

• BMI >35kg/m2 (Fat)
• primigravida (First)
• Family history of preeclampsia (Family)
• interpregnancy interval >10 years (Far)
• 40 years old and above (Forty)
• multiple pregnancy (Fetus)

Question 21

Indications for delivery (5)

Answer 21

• inability to control BP on 3 maxed out agents
• worsening biochemical markers: platelet <100, creatinine >90 umol/l, albumin <20g/l
• eclampsia, pulmonary edema, stroke
• symptoms of impending eclampsia
• fetal compromise: fetal distress, severe for, reversed umbilical artery diastolic flow

Question 22

MOA : nifedipine

Answer 22

Calcium channel blocker

Question 23

MOA: Labetolol

Answer 23

Alpha and beta adrenergic blocker

Question 24

MOA: hydralazine

Answer 24

Direct smooth muscle relaxant resulting in vasodilation

Question 25

MOA methyldopa

Answer 25

Alpha adrenergic agonist - reduced total peripheral resistance - decreased systemic blood pressure

Question 26

MgSO4 therapeutic Range

Answer 26

2-4 mmol/l

Question 27

MgSO4 toxicity level

Answer 27

3.5-5 mmol/l

Question 28

Incidence HELLP Syndrome

Answer 28

0.5-0.9%

Question 29

Risk of placental abruption with preexisting HTN

Answer 29

4%

Question 30

HELLP syndrome recurrence Developed <32 weeks

Answer 30

60%

Question 31

HELLP Syndrome recurrence Developed @>32 weeks

Answer 31

10%

Question 32

Percentage of patients who present with eclampsia that have severe htn

Answer 32

40%

Question 33

Recurrence rate of eclampsia

Answer 33

10%

Question 34

Maternal mortality associated with eclampsia

Answer 34

0.4- 5.8%

Question 35

Mortality rate of eclampsia

Answer 35

1:50

Question 36

Findings if the ASPRE study

Answer 36

- reduction in delivery with pre eclampsia before 37 weeks with the use of asa 150mg from 4.3% to 1.6%

Question 37

Percentage of patients with pre eclampsia who develop HELLP syndrome

Answer 37

5-20%

Question 38

What percentage of patients develop HELLP postpartum

Answer 38

25%

Question 39

Is HELLP always preceeded by hypertension and proteinuria?

Answer 39

No 1/3 patient would have neither

Question 40

Mortality rate of HELLP

Answer 40

1% in resource rich countries

Question 41

Perinatal mortality with HELLP

Answer 41

7-60%

Question 42

Overall risk of hypertensive disorders in pregnancy

Answer 42

8-10%

Question 43

Risk preeclampsia in subsequent pregnancy if eclampsia lead to birth <28weeks

Answer 43

55%

Question 44

What are renal function test indicate AKI in pregnancy

Answer 44

-Serum Urea >17mmol/l requires renal replacement therapy - creatinine >90umol/l

Question 45

What percentage of patients with HELLP syndrome have AKI

Answer 45

3-15%

Question 46

What percentage of patients with pre eclampsia develop AKI

Answer 46

Up to 2 %

Question 47

What percentage of women with untreated APS develop GHTN/preeclampsia

Answer 47

30-50% Decreases to 10% with treatment