blood pressure in pregnancy

Question 1

BP rises/falls in early pregnancy

Answer 1

falls due to vasodilatation

Question 2

after 24 weeks, BP increases/decreases

Answer 2

increases due to increased SV

Question 3

if hypertension in early pregnancy (<24 weeks) what is most likely cause

Answer 3

pre-existing hypertension

Question 4

complications of hypertension in pregnancy

Answer 4

Pre-eclamptic toxaemia (PET)
IUGR
placental abruption

Question 5

what medications should not be used in pregnancy

Answer 5

ACE inhibitors
A2A blockers
thiazide diuretics

Question 6

what medications should be used in pregnancy

Answer 6

labetalol
methyldopa
aspirin

Question 7

why should just oxytocin be given during labour and not oxytocin with ergometrine

Answer 7

ergometrine can cause severe hypertension

Question 8

what is pre-eclampsia

Answer 8

hypertension
proteinuria
oedema

Question 9

time of early pre-eclampsia

Answer 9

<34 weeks

Question 10

time of late pre-eclampsia

Answer 10

> 34 weeks

Question 11

early/late pre-eclampsia if higher risk

Answer 11

early

Question 12

early/late pre-eclampsia is more common

Answer 12

late

Question 13

stage one of pre-eclampsia

Answer 13

abnormal placental diffusion (ischaemia)

Question 14

stage 2 of pre-eclampsia

Answer 14

maternal syndrome - anti angiogenic state associated with endothelial dysfunction

Question 15

CNS manifestations of pre-eclampsia

Answer 15

eclampsia 
hypertensive encephalopathy
intracranial haemorrhage 
cerebral oedema 
cortical blindness
cranial nerve palsy

Question 16

hepatic disease in pre-eclampsia

Answer 16

epigastric/RUQ pain
abnormal LFTs
hepatic capsule rupture
HELLP syndrome

Question 17

cardiac/pulmonary disease in pre-eclampsia

Answer 17

pulmonary oedema

pulmonary embolus

Question 18

placental disease in pre-eclampsia

Answer 18

foetal growth restriction
placental abruption
intrauterine dearh

Question 19

symptoms of pre-eclampsia

Answer 19

headache
visual disturbance 
epigastric/RUQ pain
nausea/vomiting 
rapidly progressive oedema

Question 20

management of pre-eclampsia

Answer 20

treat hypertension

Question 21

risk factors for pre-eclampsia

Answer 21

maternal age >40
maternal BMI>30 
family history 
single paritiy
multiple pregnancy
prev PE
molar pregnancy 
pre-existing renal/connective tissue disease/diabetes/hypertension/thrombophilia

Question 22

why is aspirin given in pre-eclampsia

Answer 22

inhibits cyclo-oxygenase preventing TXA2 synthesis

Question 23

investigations for pre-eclampsia

Answer 23

raised protein-creatinine ratio
raised serum uric acid 
thrombocytopenia 
abnormal LFTs 
nothcing of uterine artery on Doppler and abnormal umbilical arteries

Question 24

when should patients with pre-eclampsia be admitted

Answer 24

BP >170/110 or 140/90 with proteinuria 
significant symptoms (headache/vision/abdo pain 
abnormal biochemistry
significant proteinuria 
need for antihypertensives 
signs pf foetal compromise

Question 25

1st line treatment of pre-eclampsia

Answer 25

methyl dopa (a agonist)labetalol (a and b antagonist)
nifedipine (CCB)

Question 26

2nd line treatment for pre-clampsia

Answer 26

hydralazine (vasodilator)

doxazocin (a antagonist)

Question 27

indications for birth

Answer 27

inability to control BP
term gestation 
rapidly deteriorating 
eclampsia
foetal compromise

Question 28

what is eclampsia

Answer 28

tonic-clonic seizure occurring with features of pre-eclampsia (obstetric emergency)

Question 29

most common group of people to get eclampsia

Answer 29

teenagers

Question 30

management of eclampsia

Answer 30

control BP
stop/prevent seizures
fluid balance
delivery

Question 31

what medication for hypertension in eclampsia

Answer 31

IV labetolol

IV hydralazine

Question 32

what medication to stop/prevent seizures in eclampsia

Answer 32

magnesium sulphate

Question 33

main cause of maternal death in eclampsia

Answer 33

pulmonary oedema