Hypertension and Pre-ecampsia

Question 1

define pre-eclampsia (3 parts to the definition)

Answer 1

hypertension…

…occurring after 20 weeks gestation…

…with associated end organ damage

Question 2

triad of pre-eclampsia

Answer 2

hypertension

proteinuria

oedema

Question 3

define pregnancy induced hypertension

therefore the difference with this and pre-eclampsia is..

Answer 3

new onset HTN after 20 weeks gestation

the difference is the presence/absence of end organ damage

Question 4

what is eclampsia?

Answer 4

seizure occurring in a patient with known pre-eclampsia

Question 5

what is the basic pathophysiology that leads to gestational HTN and pre-eclampsia?

Answer 5

failure of the development of placental lacunae

the placenta doesn’t get enough blood and this causes oxidative stress

the placenta releases inflammatory signals into the mother’s circulation and this impairs endothelial function

Question 6

5 high risk factors for pre-eclampsia

Answer 6

previous pre-eclampsia or gestational HTN

pre-existing HTN

pre-existing autoimmune conditions (such as SLE)

diabetes

CKD

Question 7

6 moderate risk factors for pre-eclampsia

Answer 7

multiple pregnancy

first pregnancy

more than 10 years since last pregnancy

BMI >35

age >40

FHx of pre-eclampsia

Question 8

patients are offered aspirin from 12 weeks gestation if they have how many high or moderate risk factors?

Answer 8

all patients with any high risk factor

all patients with 2 or more moderate risk factors

Question 9

for prophylaxis of pre-eclampsia, aspirin is given from 12 weeks gestation until

Answer 9

birth

Question 10

7 signs/symptoms of pre-eclampsia

Answer 10

headache
blurred vision/vision changes
upper abdominal pain (liver swelling)
N+V
oedema

reduced urine output
brisk reflexes

Question 11

diagnosis of pre-eclampsia can be made with (1 + 1/3)

Answer 11

Systolic of 140 or diastolic of 90 PLUS

proteinuria 1+ or more on dipstick OR

organ dysfunction OR

placental dysfunction

Question 12

5 ways that organ dysfunction may manifest in pre-eclampsia (other than proteinuria)

Answer 12

raised creatinine

raised LFTs

low platelets

haemolytic anaemia

seizures

Question 13

2 ways that placental dysfunction can present in pre-eclampsia

Answer 13

foetal growth restriction

abnormal doppler studies

Question 14

abnormal proteinuria:

protein/creatinine

albumin/creatinine

Answer 14

30mg/mmol

8mg/mmol

Question 15

what is the use of taking a placental growth factor between 20 and 35 weeks?

Answer 15

it can be used to rule out pre-eclampsia if it is normal

Question 16

what will the PlGF be in pre-eclampsia?

Answer 16

low (PlGF stimulates the development of new blood vessels - therefore if it is low this suggests that new blood vessels are not developing)

Question 17

at what blood pressure are pregnant patients admitted for antihypertensives?

Answer 17

160/110

Question 18

uggest 3 additional screening measures that patients with gestational hypertension will have

Answer 18

weekly urine dip for protein

foetal growth will be assessed with serial scans

FBCs and LFTs weekly to check for other manifestations of organ dysfunction

Question 19

2 scoring systems for the severity of pre-eclampsia

Answer 19

fullPIERS

PREP-S

Question 20

how frequently should blood pressure be taken in patients with pre-eclampsia?

Answer 20

every 48 hours at least

Question 21

true or false: urine dipstick should be performed every 48 hours in patients with pre-eclampsia

Answer 21

false - there is no need to do a urine dipstick on patients who are already diagnosed with pre-eclampsia

Question 22

how is the health of the foetus monitored in patients with pre-eclampsia?

Answer 22

USS and dopplers to check foetal growth and amniotic fluid every 2 weeks

Question 23

first, second and third line antihypertensives in pregnancy

Answer 23

labetalol

modified release nifedipine

methyldopa

Question 24

which antihypertensive is likely to be given in the management of pregnant patients with malignant hypertension?

Answer 24

IV hydralazine

Question 25

2 situations in which IV magnesium sulphate is given in pre-eclampsia

Answer 25

when it progresses to eclampsia

during labour and 24 hours afterwards (as prophylaxis)

Question 26

how can fluid overload be avoided in severe pre-eclampsia/eclampsia?

Answer 26

fluid restriction is often given at birth

Question 27

what is the definitive management of pre-eclampsia?

Answer 27

delivery

Question 28

what is the dose of magnesium sulphate given for eclampsia?

Answer 28

4g

Question 29

AE of MgSO4

how is this counter-acted?

Answer 29

respiratory depression

calcium can be given to reverse this

Question 30

what is HELLP syndrome?

Answer 30

haemolysis

elevated liver enzymes

low platelets

Question 31

how does HELLP syndrome present? (symptoms)

Answer 31

N+V

lethargy

RUQ pain

Question 32

what is the management of HELLP syndrome?

Answer 32

delivery

Question 33

suggest why pre-eclampsia could lead to breathlessness

Answer 33

oedema —-> pulmonary oedema

Question 34

what causes local symptoms in pre-eclampsia?

Answer 34

local vasoconstriction e.g. reduced blood flow to the liver causes RUQ pain

Question 35

why does pre-eclampsia cause low platelets and haemolysis?

Answer 35

pro-inflammatory signals cause the formation of many small thrombi in the blood vessels

RBCs collide with these and haemolyse