Hypertensive disorders

Question 1

Risk factors of hypertension in context of obs x6

Answer 1

Nulliparity
Preexisting DM
Preexisting HTN
Age <20 or >35
Gestational diabetes
Multiple pregnancy

Question 2

5 classes of HTN in pregnant women

Answer 2

Eclampsia
Preeclampsia
Gestational HTN
Chronic HTN
Chronic HTN with superimposed preeclampsia

Question 3

When can chronic HTN be detected x3

Answer 3

1. Detected before pregnancy
2. Persists after 12 weeks postnatal
3. Detected in first 20 weeks of pregnancy

Question 4

Causes of chronic HTN x5

Answer 4

SLE
Diabetic nephropathy
Diabetes mellitus
Renal artery stenosis
Pheochromocytoma

Question 5

Management of chronic hypertension x3

Answer 5

First line- methyldopa/nifedipine
Second class- hydralazine

Question 6

Risk factors of developing superimposed preeclampsia x6

Answer 6

Preexisting diabetes
Renal disease
Maternal age >40
Previous preeclampsia
Multiple pregnancy
Pre pregnancy BMI>35

Question 7

Why avoid NSAIDs in postpartum women with chronic HTN

Answer 7

NSAIDs promote salt and water retention which results in exacerbated HTN and worsening kidney function

Question 8

Pharmacotherapy target in chronic HTN x2

Answer 8

<150/100 in uncomplicated BP
< 140/90 if there is target organ damage

Question 9

How to monitor patients with gestational HTN x3

Answer 9

1. BP checks once/twice a week
2. Weekly measurements of proteins and liver enzymes
3. Monitor fetal growth

Question 10

What features elevates gestational HTN to preeclampsia x3

Answer 10

Proteinuria
Thrombocytopenia
Elevated liver enzymes
#HELLP syndrome

Question 10

When to deliver in gestational HTN w/o complications

Answer 10

39+6 weeks

Question 11

Risks or complications caused by pregnancies of women with Severe GDM x3

Answer 11

Preterm delivery
Small for GA
Abruption of placenta

Question 12

Define preeclampsia

Answer 12

HTN >140/110 appearing after 20 weeks GA with proteinuria 2+ and signs of potential organ damage

Question 13

Morphological changes of placentas affected by preeclampsia x2

Answer 13

Areas of necrosis
Basal hematomas

Question 14

Risk factors of preeclampsia x5

Answer 14

Family history of preeclampsia
BMI>35
Multiple pregnancies
First pregnancy
Preexisting renal D, DM, HTN

Question 15

Describe two things that occur during abnormal placentation

Answer 15

1. Failure of trophoblast to invade the myometrial tissue containing spiral arterioles
2. Failure of spiral arterioles to become wide bore, low resistance and high capacity vessels

Question 16

Signs seen on examination of a patient with preeclampsia x5

Answer 16

RUQ tenderness
Papilloedema
Facial edema
Poor urine output
Hyperreflexia and clonus

Question 17

Fetal complications of preeclampsia x5

Answer 17

HIE
Oligohydramnios
Prematurity
Early fetal death
Acute and chronic uteroplacental insufficiency

Question 18

Biochemistry results in preeclampsia x5

Answer 18

Low Hb
High Hct
Low platelets
ALT, AST > x2
Elevated creatinine

Question 19

Pharmacological management of preeclampsia x2 and BP target

Answer 19

Oral nifedipine
IV hydralazine
Target < 160/85

Question 20

Seizure prophylaxis in preeclampsia

Answer 20

Magnesium sulphate

Question 21

What is used to counteract magnesium toxicity

Answer 21

Calcium gluconate

Question 22

Indications of delivering at 34weeks GA in preeclampsia x4

Answer 22

Pulmonary edema
Progressive thrombocytopenia
Progressive elevated liver enzymes
Repeated high BPs on maintenance treatment

Question 23

Define preeclampsia superimposed on chronic HTN

Answer 23

Development of proteinuria and significant end organ dysfunction after 20weeks GA in a woman with chronic hypertension

Question 24

What is preeclampsia with severe feature x5

Answer 24

Thrombocytopenia Pulmonary edema Elevated liver transaminases New onset or worsening renal insufficiency Severe BPs despite escalated anti HTN therapy

Question 25

Define eclampsia

Answer 25

It is the development of grand mal seizures in a woman with preeclampsia in the absence of other neurologic conditions

Question 26

Clinical features of eclampsia x5

Answer 26

Seizures Headache- frontal, occipital, thunderclap Cortical blindness Blurred vision Diplopia RUQ/epigastric pain

Question 27

Treatment goals of eclampsia x4

Answer 27

Treatment of severe HTN Prevent recurrent seizures Evaluation of prompt delivery Prevention of maternal hypoxia and trauma

Question 28

Management of HTN in eclampsia in emergencies (1) and non emergencies (2)

Answer 28

Hydralazine Methyldopa Nifedipine

Question 29

Signs of magnesium sulphate toxicity x4

Answer 29

Cardiac arrest Muscle paralysis Respiratory depression Loss of deep tendon reflexes

Question 30

4 factors to consider when determining mode of delivery in eclampsia

Answer 30

GA Fetal position Cervical status Labor status

Question 31

Indications of delivery in patients with HELLP syndrome x2

Answer 31

GA> 34 weeks Deteriorating maternal or fetal status

Question 32

Maternal complications of HELLP Syndrome x4

Answer 32

DIC Stroke Pulmonary edema Abruptio placentae

Question 33

What prophylaxis is given to women at risk of preeclampsia

Answer 33

Low dose aspirin which prevents formation of substances that cause inflammation involved in abnormal placentation Aspirin promotes blood flow

Question 34

Management of preeclampsia with severe features x4

Answer 34

IV hydralazine MgSO4 prophylaxis Antenatal corticosteroid therapy Delivery after stabilization