Hypertension in pregnancy

Question 1

Pre-eclampsia

• Definition
• Presentation

Answer 1

Maternal hypertension and proteinuria in pregnancy from week 20.

• SBP >140
• DBP >90
• 2 separate occasions, >4 hours apart

Question 2

HELLP syndrome

Answer 2

Syndrome of severe pre-eclampsia

Haemolysis

Elevated liver enzymes

• AST
• ALP is physiologically elevated in pregnancy

Low platelets
- Platelet levels <200

Question 3

Other organ dysfunctions in pre-eclampsia

Answer 3

Fetal

- IUGR

Question 3

Investigations in pre-eclampsia

Answer 3

BP

• > 140/90
• Severe= >160/110

FBC
- Haemolysis, platelet count (HELLP)

Urinalysis

• Protein dip 1+
• Albumin: creatinine ratio > 8, protein:creatinine >30

LFTs
- Elevated AST/ALT (>70 IU/L)

Fetal ultrasound
- Monitor fetal growth (IUGR)

Question 4

High risk factors for pre-eclampsia

Answer 4

Previous pre-eclampsia/ Gestation hypertension

Diabetes

Pre-existing Hypertension

CKD

Autoimmune disease

Question 5

Eclampsia

- Description

Answer 5

Seizure in pregnancy women due to underlying hypertension.

Question 6

Management of pre-eclampsia

• High risk
• New diagnosis

Answer 6

High risk

• PO aspirin 150mg from week 12 until birth
• Healthy lifestyle

Blood pressure control, aim 130/90

• Labetalol
• Nifedipine
• Metyldopa

Question 7

Management of acute eclampsia

Answer 7

Obstetric and paediatric emergency

1. ABCDE
2. Anticonvulsant: MgSO4
3. BP control: IV labetolol (or PO nifedipine/ IV hydralazine)

Fluid restriction

Fetal monitoring after seizure has subsided

Oral corticosteroids is preterm birth is likely

Question 8

MgSO4 dose during acute eclampsia

Answer 8

1. Loading dose= 4g
2. Maintenance dose= 1g/Hr

If seizure continuous= bolus dose = 2-4g

Question 9

First line management of hypertension in pregnancy

Answer 9

Labetalol

Question 10

Signs/ symptoms of severe pre-eclampia

Answer 10

Symptoms

• Severe Headache
• Visual disturbance: flashing lights,
• LUQ/ epigastric pain

Signs

• Clonus/ brisk reflexe
• papilloedema

Bloods

• Platelets < 100
• Cr >100
• ALT >50

Question 11

Urine protein:creatine ratio of ______ is significant proteinuria in pre-eclampisa

Answer 11

> 30

Question 12

24 hour urinary protein of ______ is significant proteinuria for pre-eclampsia

Answer 12

> /= 300

Question 13

Physiological BP in pregnancy

Answer 13

Falls in first trimester

Stabilises in 2nd

Rises in 3rd

Question 14

Essential hypertension in pregnancy is likely when…

Answer 14

<20 weeks

• Hypertensive at booking

Question 15

Most common cause of death in pre-eclampsia/ eclampsia

Answer 15

Intracranial haemorrhage

Question 16

Maternal complications of DM

• Cerebral
• Respiratory
• RENAL
• Haem

Answer 16

Cerebral
- Seizure, haemorrhage

Pulmonary
- PE, oedema

Renal= AKI

Liver= acute fatty liver of pregnancy

Haem= HELLP

Question 17

Foetal complications of DM

Answer 17

Placental abruption

Oligohydraminos

IUGR

Risk of HTN and stroke

Question 18

Vaginal delivery in pre-eclampsia can be considered from..

Answer 18

week 34

Question 19

Moderate risk factors for pre-eclampsia

Answer 19

Age >40

Family history

• Mother
• Sister

Obesity
- BMI >35

Nulliparous, increased inter-pregnancy (>10 years)

Multiple pregnancy

Question 20

Birth in pre-eclampsia should be planned when?

Answer 20

At 37 weeks

- Within 24-48 hours