Hypertension and Pre-eclampsia

Question 1

Pre-existing HTN diagnosed in pregnancy investigations and management

Answer 1

Investigations
- Radial femoral delay - coarctation of the aorta
- Urinalysis and U&E + Cr, serum Ca2+ (hyperparathyroidism)
- Catecholamines (urinary)
- USS for renal artery stenosis, auscultating for renal bruits

Management
- PET screen each trimester
- Appropriate meds
- Aspirin and C2+
- UA dopplers
- Growth scans

Question 2

Pre-eclampsia
Cause

Risk factors
Management

Crisis

Answer 2

Cause: widespread/diffuse vascular endothelial disfunction causing circulatory disturbance involving renal, CVS, hepatic, CNS and coagulation. Eg HTN, proteinuria, oedema.
Risk factors: Primips, chronic systemic inflammation (BMI, HTN, renal disease, APLS, SLE, sickle cell), genetics, immune, prev, multiples, long birth interval, molar

Crisis:
Eclampsia, HELLP, abruption, DIC, pulmonary oedema, CVS haemorrhage, renal or hepatic failure, cortical blindness, transient left ventricular dysfunction.

Risks to further HTN, IHD, CVD, CKD