Hypertension and pre-eclampsia

Question 1

What is the management of hypertension in pregnancy?

Answer 1

1. Labetolol
2. Methyldopa, nifedipine
   Aim to maintain BP <135/85
   Monitor for pre-eclampsia and foetal growth

Question 2

What is chronic hypertension?

Answer 2

Pre-pregnancy or develops before 20 weeks

Question 3

What is gestational hypertension?

Answer 3

Pregnancy induced hypertension >20 weeks gestation

Question 4

What is pre-eclampsia?

Answer 4

Hypertension and proteinuria

Question 5

What are the risk factors for pre-eclampsia?

Answer 5

First pregnancy 
PMH/FH pre-eclampsia 
>40
BMI >35 
CKD
Multiple pregnancy
Chronic/gestational hypertension

Question 6

What is the presentation of pre-eclampsia?

Answer 6

Headache, blurred vision, Papilloedema
Seizures 
Epigastric and RUQ pain, vomiting
Oedema 
Clonus, brisk reflexes 
Reduced urine output

Question 7

How is pre-eclampsia diagnosed?

Answer 7

Proteinuria + one of

• > 140 or >90 twice OR
• > 160 once

Question 8

What investigations are done for pre-eclampsia?

Answer 8

BP
Urinalysis= proteinuria >0.3g/day
FBC- haemolytic anaemia, low platelets
U&Es, LFTs- Increased LFTs, urea and creatinine

Question 9

What is the general management of pre-eclampsia?

Answer 9

Monitor BP, foetal growth and CTG and urine output 
Antihypertensive
-1. Labetolol
-2. Nifedipine, methyldopa
Fluid restriction

Question 10

What is the management of seizures in pre-eclampsia?

Answer 10

IV magnesium sulphate

Question 11

How is pre-eclampsia prevented?

Answer 11

Low dose aspirin from 12 weeks

Question 12

What are the maternal complications of pre-eclampsia?

Answer 12

Seizures 
Stroke 
Cerebral haemorrhage 
Haemolysis 
Renal failure 
Pulmonary oedema 
Heart failure 
DIC

Question 13

What are the foetal complications of pre-eclampsia?

Answer 13

Impaired placental function- growth restriction, foetal distress, prematurity, increased mortality