ANC - Hypertensive disorders in pregnancy

Question 1

Def pre-existing HTN in pregnancy

Answer 1

> 140mmHg before pregnancy/<20W

Question 2

How does pre-existing HTN affect your risk of pre-eclampsia

Answer 2

6x incr risk

Question 3

Mx HTN in pregnancy (2)

Answer 3

1st line = lobetalol

Deliver 38-40w

Question 4

When is blood pressure lowest in pregnancy

Answer 4

2nd trimester

Question 5

Def pregnancy induced HTN

Answer 5

BP >140/90 >20w

Question 6

What are the 2 main causes of pregnancy induced HTN?

Answer 6

Pre-eclampsia

Transient HTN

Question 7

Def pre-eclampsia

Answer 7

Multisystem syndrome that = usually manifests as new HTN after 20w w/ signif proteinuria

Question 8

What is the only cure for pre-eclampsia

Answer 8

Delivery

Question 9

What are the 2 pre-eclampsia phenotypes?

Answer 9

Early onset

Late onset

Question 10

What is early onset pre-eclapmsia

Answer 10

Causing complications before 34w –> growth restriction

Question 11

What is late onset pre-eclampsia

Answer 11

> 34w + NOT assoc w/ growth restriction

Question 12

Pathophysiology - 1st step of pre-eclampsia - early onset

Answer 12

Incomplete trophoblastic invasion of spiral aaa –> decr placental perfusion

Question 13

Pathophysiology - 1st step pre-eclampsia - late onset

Answer 13

Intervillous perfusion reduces (has reached its limit)

B/c terminal are overcrowded + oxidative stress

Question 14

Pathophysiology - 2nd step pre-eclampsia

Answer 14

Placenta oversecretes proteins that regulate angiogenic balance
Widespread endothelial damage, vasoconstrictoin, clotting dysfunction

Question 15

% pre-eclampsia nulliparous F

Answer 15

6%

Question 16

% recurrence in prev pre-eclampsia mother

Answer 16

15%

Question 17

pt @ high risk pre-eclampsia (5)

Answer 17

HTN disease of preg
CKD
Autoimmune disease 
T1/2DM 
Chronic HTN

Question 18

pt @ moderate risk pre-eclampsia (6)

Answer 18

Nulliparous 
Age >40 
Pregnancy intervals >10y
BMI >35 @booking 
FHx pre-eclampsia 
Multiple pregnancy

Question 19

CF pre-eclampsia (6)

Answer 19

Usually asymp 
Headache
Drowsy
Visual disturbances
N+V
Epigastric pain

Question 20

O/E Pre-eclampsia (4)

Answer 20

HTN
Oedema - massive
Presence epigastric tenderness
Urine dip ++ proteins

Question 21

Maternal complications - pre-eclampsia (5)

Answer 21

can --> eclampsia --> grand mal seizures 
Cerebrovascular haemorrhage
Liver + coag problems (HELLP syndrome) 
Renal failure 
Pulmonary oedema

Question 22

Fetal complications of pre-eclampsia (4)

Answer 22

IUGR
Preterm birth
Placental abruption
Hypoxia

Question 23

Features of HELLP syndrome

Answer 23

H - Haemolysis (dark urine, raised LDH, anaemia)
EL - Elevated liver enzymes (epigastric pain, liver failure, abnorm clotting)
LP - Low platelets

Question 24

Ix pre-eclampsia (5)

Answer 24

Bedside urine dip 
PCR
Monitor maternal complications - FBC/U+E/LFT
USS
CTG + umbilical aa doppler

Question 25

Prevention pre-eclampsia

Answer 25

75mg aspirin before 16w to F at risk

Question 26

Drugs used in Mx pre-eclampsia

Answer 26

Nifedipine PO during preg
2nd line IV labetalol
IV MGSO4

Question 27

Signs of MgSO4 toxicity (6)

Answer 27

Resp depression 
HOTN
Hyporeflexia
Somnolence
Paralysis 
Cardiac arrest

Question 28

Mx pre-eclampsia <34w

Answer 28

CSC

Question 29

Mx pre-eclampsia >34w (8)

Answer 29

IOL (PG) 
Epidural can reduce BP 
CTG
BP + monitored closely 
AntiH 
Avoid pushing in 2nd stage
Oxytocin NOT ergometrine 3rd stage

Question 30

Post-natal care pre-eclampia (5)

Answer 30

LFT/platelets/renal fct monitored
Fl balance monitored
BP monitored - B blocker
May req Tx for several w 
LT - comm w/ GP + Midwives

Question 31

Which LFT is always raised in pregnancy

Answer 31

ALP

Question 32

MgSO4 dosing in pre-eclampsia/eclampsia

Answer 32

4g IV MgSO4 stat

Then 1-2g/hr for 24h

Question 33

Fl restriction for pre-eclamptic F in labour

Answer 33

80ml/hr or 1ml/kg/hr

Question 34

Antidose MGSO4 toxicity

Answer 34

1g IV Calcium gluconate