Hypertension

Question 1

What is the normal course of blood pressure in a pregnancy individual?

Answer 1

Decreases in the early stages, low at 22 weeks
Gradually increases again until delivery
Will see a drop PP but again rise and peak at 2-4 days PP

Question 2

What percentage of people will get hypertension in pregnancy?

Answer 2

10-15%

Question 3

Who is most commonly affected by pre-eclampsia

Answer 3

primagravida

Question 4

What meets the criteria for hypertension in pregnancy?

Answer 4

> 140/90 on 2 occassions
160/110 on 1 occassion
30/15 from first trimester

Question 5

What is the criteria for pre-clampsia?

Answer 5

Hypertension, oedema and proteinuria

Question 6

When is hypertension considered to not be related to pregnancy?

Answer 6

Diagnosis before pregnant or maintained hypertension for > 3months

Question 7

How will most present with pre-eclampsia?

Answer 7

Asymptomatic - picked up at antenatal screening

Question 8

What is classified as early and late pre-eclampsia?

Answer 8

Early = < 34 weeks (if less than 20 weeks then investigate for other pathology)
Late = > 34 weeks (majority of cases)

Question 9

Is pre-eclampsia a multisystem disease?

Answer 9

YES - it can involve the CV, CNS, pulmonary, renal, hepatic, haematological, and placental circuits

Question 10

Explain the renal involvement in pre-eclampsia

Answer 10

decreased GFR, altered U&Es, oligouria/anuria, serum urate elevated, AKI (acute tubular necrosis, cortical necrosis)

Question 11

Explain the liver involvement in pre-eclampsia

Answer 11

RUQ pain, LFTs deranged, can have hepatic capsule rupture and HELLP syndrome develop

Question 12

What is HELLP syndrome?

Answer 12

Haemolysis
Elevated Liver enzymes
Low Platelets

Question 13

Explain the CNS involvement in pre-eclampsia?

Answer 13

Clonus, cerebral oedema, cortical blindness, hypertensive encephalopathy, intracranial haemorrhage, CN palsy

Question 14

Explain the CVS/pulmonary involvement in pre-eclampsia

Answer 14

pulmonary oedema - can lead to ARDS

Question 15

Explain the haematological involvement in pre-eclampsia

Answer 15

reduced PV, thrombocytopenia, DIC, haemolysis

Question 16

Explain the placental involvement in pre-eclampsia

Answer 16

FGR, IUD or placental abruption

Question 17

How is pre-eclampsia investigated?

Answer 17

U&E, serum urate, LFTs, FBC, coag, BP, urine PCR, CTG, USS

Question 18

How is pre-eclampsia managed?

Answer 18

Control BP (methyldopa or labetolol), monitor for changes, give prophylactic steroids

Question 19

If have risk factors for pre-eclampsia then what can be done to reduce risk?

Answer 19

LDA (75mg) from 12 weeks until birth

Question 20

What are some risk factors for pre-eclampsia?

Answer 20

Previous in past pregnancy, >40 yrs, BMI >30, FHx, nulliparous (primagravida), multiple pregnancy

Question 21

What is the only way to treat pre-eclampsia?

Answer 21

Delivery of foetus

Question 22

What are symptoms/signs of pre-eclampsia?

Answer 22

hypertension, oedema, proteinurea, headache, visual disturbance, disorientation, RUQ pain, N+V, SGA, FGR, IUD

Question 23

What is eclampsia?

Answer 23

This is a generalised tonic clonic that may present before the onset of hypertension/proteinurea

Question 24

When can eclampsia present?

Answer 24

antepartum (38%)
intrapartum (16%)
postpartum (44%)

Question 25

How do you manage eclampsia - control of BP?

Answer 25

IV labetolol and IV hydralazine

Question 26

How do you manage eclampsia - control seizure?

Answer 26

IV MgSO4 
loading dose = 4g
maintenance dose = 1g/hr
if another seizure then give 2g MgSO4
if another after that then give 10mg IV diazepam

Question 27

How do you manage eclampsia - delivery?

Answer 27

aim for vaginal with epidural - avoid ergometrine

Question 28

How do you manage eclampsia - fluids?

Answer 28

It is better to run a patient dry as the risk of fluid overload and pulmonary oedema is high.