Hypertensive Disorders

Question 1

Risks of chronic hypertension x3

Answer 1

Increased risk of developing pet
Increased risk of iugr
Increased risk of placental abrupt ion

Question 2

Degrees of chronic hypertension

Answer 2

Mild, moderate and severe

Question 3

Definition of mild chronic hypertension

Answer 3

140-149/90-99

Question 4

Definition of moderate chronic hypertension

Answer 4

150-159/100-109

Question 5

Definition of severe chronic hypertension

Answer 5

> 160/>110

Question 6

Pregnancy induced hypertension

Answer 6

Development of blood pressure above 140/90 after 20/40 without proteinuria

Question 7

Risks of PIH x1

Answer 7

Increased risk of PET

Question 8

Antenatal care for a patient with PIH x3

Answer 8

Regular A/N checks - bp and urinalysis
Education on symptoms of PET
Anti hypertensives if BP persistently >150/90

Question 9

Maternal Risk factors for PET x6

Answer 9

Maternal family hx 
Personal hx of condition 
Ethnic background 
Greater interval between pregnancies 
Age 40
Multiple pregnancy

Question 10

Medical disorder risk factors for PET x6

Answer 10

Chronic hypertension
Renal disease 
Obesity 
Diabetes mellitus 
Adverse lipid profile 
Thromboembolic disorders

Question 11

Systems affected by PET x5

Answer 11

Cardiovascular 
Renal 
Liver 
Neurological 
Fetoplacental

Question 12

When will signs of PET show

Answer 12

2nd half of pregnancy

Question 13

Interplay of factors resulting in PET x3

Answer 13

Genetic predisposition
Immunological
Placental development/implantation

Question 14

Placenta ischiaemia - pregnancies complicated by PET point 1

Answer 14

2nd wave of trophoblast cell invasion of spiral arterioles in 2nd trimester is abnormal = impaired perfusion of placental tissue

Question 15

Placenta ischiaemia - pregnancies complicated by PET point 2

Answer 15

Spiral arteries remain intact endothelial and smooth muscle linings. They undergo less dilitation than expected.

Question 16

Placenta ischiaemia - pregnancies affected by PET point 3

Answer 16

Development differences are thought to result in factors being released into maternal circulation.
These could be responsible for placental dysfunction, vasoconstriction and hypertension.

Question 17

Placenta ischiaemia - damage to endothelial cells will: x4

Answer 17

Reduce production of prostacyclin and nitric oxide
Increase vascular sensitivity to angiotension 2
Activates coagulation cascade and production of thromboxane
Increases production of lipid per oxides and decreases antitoxidants

Question 18

Placenta ischiaemia - a result of endothelial dysfunction

Answer 18

Circulating factors are released from placenta in response to hypoxia resulting from under perfusion

Question 19

Placenta ischiaemia - what do endothelial cells form?

Answer 19

Endothelium

Question 20

Placenta ischiaemia - what do endothelium do? X4

Answer 20

Line cv system
Play role in regulating capillary transport
Role in modulating vascular smooth muscle reactivity in response to various stimuli
Form inner lining of blood vessels

Question 21

What study suggests length of sexual relationship is related to incidence of PET?

Answer 21

Robillard et al 1994

Question 22

What is a sexual relationship of

Answer 22

A 7 fold increase in HDP

Question 23

Partial explanation for increase incidence of HDP with x5

Answer 23

Nulliparity
Primiparity 
Teenage pregnancy 
Aids 
Previous hx of pet with male partner

Question 24

Effects of placenta ischaemia and endothelial disruption x9

Answer 24

Generalised vasoconstriction 
Increase systemic vascular resistance 
Increase vascular hydrostatic pressure 
Decrease in tissue perfusion
Multiple organ dysfunction/damage 
Increase in vascular permeability 
Oedema 
Decrease in circulating plasma volume 
Haemoconcentration

Question 25

Maternal symptoms - brain vasospams x3

Answer 25

Frontal headaches Visual disturbances Seizures

Question 26

Maternal symptoms - liver micro emboli/hypoxic damage x4

Answer 26

Liver swelling Nausea and vomiting Epigastric pain Right upper quadrant pain

Question 27

Screening for hypertensive disorders properties x4

Answer 27

For those that have risks/signs at booking or f/u Continuity care results in less mistakes Regular bp and urinalysis Observe for oedema

Question 28

What is the best way to measure bp?

Answer 28

Manually as it is the optimum method for diagnosis

Question 29

What must we consider when measuring bp? X5

Answer 29

Effects of physical condition, exertion, environment, smoking, white coat syndrome

Question 30

Proteinuria x3

Answer 30

Dipstick measurement If proteinuria present obtain for msu Confirm using qualitative measurement and timed urine

Question 31

What is RBC x2

Answer 31

Main blood component | Helps asses O2 carrying capacity

Question 32

Variation in normal RBC count x2

Answer 32

Increase may indicate polcythaemia | Decrease may indicate anaemia, fluid overload and haemorrhage

Question 33

What does haematocrit value tell us

Answer 33

Reflects % of blood occupied by RBC

Question 34

Normal haematocrit value

Answer 34

35-47%

Question 35

Variation in haematocrit levels x2

Answer 35

Decrease in level may mean anaemia, MOH | Increase in levels = polycythaemia

Question 36

Haemoglobin

Answer 36

Main component of RBC

Question 37

Normal hb level

Answer 37

11 - 14 g/dl

Question 38

Variation in levels of hb x2

Answer 38

Increased levels may = haemoconcentration | Decreased levels may = anaemia, recent haemorrhage, fluid retention

Question 39

PLT normal value

Answer 39

150-400 x 109/l

Question 40

PLT role x2

Answer 40

Role in forming blood clots | Role in haemostat in process

Question 41

Increased PLT x5

Answer 41

``` Haemorrhage Pet Hellp Dic Idiopathic thrombocytopenia ```

Question 42

When do C-reactive protein concentration increase x2

Answer 42

During inflammation and infection

Question 43

What happens to GFR and u + e if excretion ability of kidney is compromised

Answer 43

Decreased GFR U and e accumulate in blood Serum concentration of both rise

Question 44

Normal urea level

Answer 44

2.5 - 6.4

Question 45

Normal creatinine level in pregnancy

Answer 45

44-73 mmol/l

Question 46

How can liver dysfunction be measured x2

Answer 46

By increased blood levels of various enzymes and metabolises usually cleared by liver

Question 47

What might increased levels of ALP enzyme indicate? X2

Answer 47

Hepatic and placental damage

Question 48

What is the role of albumin x2

Answer 48

Main plasma protein | Influences movement of fluid within capillaries

Question 49

Normal albumin value

Answer 49

Around 38g/l

Question 50

What does damage to capillaries in pet cause? X 2

Answer 50

Extra satin of plasma | Loss of plasma protein eg albumin

Question 51

What will low albumin levels result in

Answer 51

Indication for urgent delivery

Question 52

Neurological assessment x3

Answer 52

Cerebral vasospams Cerebral oedema Deep tendon reflexes

Question 53

Aims of antenatal treatment x 6

Answer 53

``` Prevent maternal death Prolong pregnancy (why) Monitor mother closely Control bp Prevent seizures Aim for optimum delivery before compromise ```

Question 54

When would antihypertensive therapy be considered?

Answer 54

With women systolic bp >150

Question 55

Where would we like to maintain diastolic bp

Answer 55

90-110

Question 56

Fetal assessment x3

Answer 56

Ultrasound growth scan/rate Doppler ultrasound assessment Biophysical profile

Question 57

Chronic hypertension

Answer 57

Blood pressure of 140/90 or > before 20/40