Medical Disorders

Question 1

CLASSIFY HTN DURING PREGNANCY

Answer 1

Gestational hypertension, eclampsia, and preeclampsia, chronic hypertension and hypertension imposed upon chronic hypertension

Question 2

DEFINE PE

Answer 2

• Hypertension with Proteinuria and/or EOD
• Not present before pregnancy - NOT Before 20 weeks of gestations - NOT After 12 weeks
  postpartum

Question 3

RISK FACTOR OF PE

Answer 3

Age - Obesity - Nulliparity - FH - Previous PE - Polyhydramnios - Hydrops fetalis -
Anti Phospholipid S - Chronic Renal Disease - Hypothyroidism

Question 4

COMPILATION OF PE

Answer 4

Eclampsia - Retinal edema and blindness - Heart Failure - Acute fatty liver up to liver failure -
Renal Failure- Placental Abruption with its complications - Fetus Fetal Distress -
Preterm Labor - IUGF - IUG

Question 5

BLOOD CHANGES DURING PE

Answer 5

-Hemoconcentration
- Platelet Thrombosis
- DIC
- Microangiopathic hemolytic Anemia
- HELLP Syndrome “ Hemolysis - Elevated liver enzymes - Low Platelet Count

Question 6

CLASSIFY PE:

Answer 6

Mild - Severe

Question 7

ENUMERATE CRITERIA OF SEVERE PE

Answer 7

• Systolic BP >= 160 mmhg - Diastolic BP >= 110 mmhg
• Symptoms of CNS dysfunction” severe headache - visual disturbance “
• Pulmonary Edema
• Hepatic abnormalities” Serum transaminase Conc >= twice normal OR persistent
  Rt upper quadrant pain “
• Renal Abnormalities “ Serum Creatinine >1.1 mg/dl0
• Thrombocytopenia < 100000/ microL
  Patient should has one or more of these criteri

Question 8

TTT OF PE

Answer 8

• Conservative TTT - if there is indications: Terminate Pregnancy by VD
• Drugs Used in PE
  *Anticonvulsant drugs “ Magnesium Sulfate “ MOST IMPORTANT “
  *Anti HTN drugs : Labetalol “1st “OR Hydralazine OR CCB “ 2nd “
• KEEP DIASTOLIC BP “ 90-100” AND GIVE IT SLOWLY
  *Continue this drugs after termination 2 or 4 days
  Don’t forget in TTT to write basic items like RNA ACC -
  Indication of Conservative- how to FU “ Write Basics first to take the full marks

Question 9

MGSO4 ACTION,

Answer 9

• Skeletal muscle relaxant
• sub cortical depression
• vasodilator
  _ cross placenta ( neuro protective. For the fetus)

Question 10

MgSO4 DOSE

Answer 10

IM or IV

IV regimen:
LD →4g IV slowly for 15-20 min
MD → 1-3 g / hr

IM regimen:
Ld→ 4g IV slowly 15-20 min then 10 (5 every buttock )
MD → 5g slowly for 4-6 hrs

Continue drug 24 to 48 hours after delivery.

Question 11

MgSO4 toxicity

Answer 11

4-7 mEq/L→ therapeutic
10 mEq/L → loss of tendon reflex
15 mEq/L → respiratory depression
25 mEq/L → cardiac arrest

Question 12

MgSO4 monitoring

Answer 12

Best to check Mg serum lvl
- Knee jerk reflects
- respiratory rate not < 16 \ min
- Pulse not < 60 \ min
- renal output not < 100 mL \ 4 hrs

Question 13

MgSO4 management of toxicity

Answer 13

Give 10ml Iv of calcium gluconate 10% over 10 minutes
O2 inhalation with EET or mechanical ventilation

Question 14

Classify eclampsia

Answer 14

80% antepartum, 15% intrapartum, 5% postpartum

Question 15

Severity of eclampsia

Answer 15

Eden’s criteria
Fits >10x, coma >6hrs
BP systolic >200 , Pulse >120 / min
Temperature > 39 c ,RR >40 / min

Question 16

Management of eclampsia

Answer 16

First aid:
Secure air way, control of falling, correction of hypoxia
Hospitalization: dark room, lie to the side
Ng504