Hypertension In Pregnancy

Question 1

Complaints in hypertension

Answer 1

Undue wt gain
High BP
Edema
Diminished urine output
Imminent eclampsia symptoms

Question 2

Grading of edema

Answer 2

Grade 1- both feet or ankles
2- both feet Plus lower limbs,hands and arms
3- generalised,pitting bilateral,feet,legs,arms,abdomen,face
4- anasarca

Question 3

Which reflex exaggerated in imminent eclampsia

Answer 3

Deep tendon reflex

Question 4

HELLP syndrome

Answer 4

Hemolysis
Elevated liver enzymes
Low platelet count

Question 5

Inv for hypertension in pregnancy

Answer 5

Urine
Albumin,protein,creatinine,pus cells,culture,glucose
Blood
Hb,platelet,bleeding time,clotting time,sugar,rft,uric acid ,lft

Question 6

Grading of thrombocytopenia

Answer 6

Grade 1->100000/ mm cube
2-50000-100000
3-<50000

Question 7

HELLP syndrome classification

Answer 7

Mississipi classification
Platelet count
Ast/ alt
Ldh

Question 8

Optic fundus examination grading

Answer 8

Grade 0- normal
1- constriction of arterioles
2- arteriolar spasm
3- edema, hemorrhage,exudates
4- papilloedema

Question 9

Gestational hypertension

Answer 9

BP 140/90 mm hg for first time after 20 weeks,in previously normotensive woman,without proteinuria

Question 10

Pre eclampsia

Answer 10

BP 140/90 or more,on two occasions,4-6 hrs apart,with proteinuria (>0.3g/l in 24 hr urine) or spot urinary protein/creatinine ratio >0.3 after 20 weeks in previously normotensive woman

Question 11

Eclampsia

Answer 11

Occurence of convulsions in patient with pre eclampsia,with no coincidental neurological disease

Question 12

Chronic hyperyension

Answer 12

Persists after 12 weeks postpartum

Question 13

Risk factors of pre eclampsia

Answer 13

Primi
Age >35 or <18
Obesity
Multiple pregnancy
Vesicular mole
Sle
History of previous
Diabetes,renal disease

Question 14

Predictors of pre eclampsia

Answer 14

Mean arterial pressure=systolic+(diastolic×2)/3
More than 90 mm in sec trimester predicts,more than 105 mm diagnostic
Gants roll over test- done at 28-30 weeks
Uterine artery notching in Doppler
Fetoplacental unit endocrine dysfucntion- HCG,AFP,Papp a ,inhibin a,placental protein 13

Question 15

Prevention of pre eclampsia

Answer 15

Low dose aspirin 75 mg
Calcium
Vit c
Vit e
Fish oil

Question 16

Anti hypertensive drugs used

Answer 16

. Labetalol 100-200 mg,bid or tid, alpha beta blockers,contra imd in asthma and CCF
. Nifedipine 10-20 mg,bid or tid,calcium channel blocker,contra imd in unstable angina,lvf
. Alpha methyl dopa 250-500 mg,tid or qid,central acting, contra imd in depression,Parkinson,angina,heart failure

Question 17

Uses of magnesium sulphate

Answer 17

. Preterm labor used as tocolytic agent,acts as neuroprotective agent upto 32 weeks
. Severe pre eclampsia, prophylaxis for eclampsia
. Eclampsia, reduces intracerebral edema and has anticonvulsant action on cerebral cortex

Question 18

Pritchards regimen

Answer 18

Loading dose- each ampoule contains 2 ml of 50% suction,equivalent to 1 g of mgso4.
4 g of 20% mgso4 given slowly iv over 3-5 mins(4 ampoules-8 ml contains 4 g mgso4,mix it with 12 ml water which makes it 20 ml of 20% mgso4)
. Followed by 5 g mgso4 im in each buttock
. 5 mg im alternate buttock evry 4 hrs,depending on bp
. Continue till 24 hrs after last fit or delivery
. Monitor knee jerk,resp rate,urine output
. Antidote-10% calcium gluconate 10 ml,slow iv 5-10 mins

Question 19

Zuspan regimen

Answer 19

4 g mgso4 iv as bolus over 10 mins,followed by 1 g/h IV infusion till 24 h after last fit

Question 20

Complications of pre eclampsia

Answer 20

Eclampsia
Preterm labor
Abruptio placenta
Oliguria and anuria
Papilloedema,cortical blindness,retinal detachment
HELLP
pulm edema
Cerebral hemorhage
Post partum collapse
CCF

Question 21

What is abruptio placenta

Answer 21

Bleeding from genital tract after 28 weeks of pregnancy before delivery of fetus

Question 22

Causes of aph

Answer 22

Abruptio placenta
Placenta previa
Circumvallate placenta
Vasa previa
Rupture of marginal sinus
Polyp,erosion,ca cervix

Question 23

Page classification of abruptio placenta

Answer 23

Grade 0- retroplacental clots after delivery
1- external bleeding only,mild uterine tetanus,no fetal or maternal distress
2- possibly external bleeding,uterine tetany and tenderness,fetal distress or death,no maternal distress or shock
3- uterine tetany,iud,maternal shock

Question 24

Complications of abruptio placenta

Answer 24

Pph
Shock
Renal failure
Maternal death
Iud
Prematurity

Question 25

Couvelaire uterus

Answer 25

In abruptio placenta,blood may extravasate into uterine musculature called uteroplacental apoplexy with dark ecchy otic changes over serosa,diagnosed during cs. Uterus may be non contractile,and contractions should be augmented by oxytocic, hysterectomy may be needed due to stop h and severe hemorrhage

Question 26

Pathology in pre eclampsia

Answer 26

Vasospasm caused by imbalance between vasodilating prostaglandins(PGI2 and PGE) and vasoconstriction prostaglandin (thromboxane A2 and PGF2 alpha) and endothelial dysfunction caused by oxidative stress