Hypertension in pregnancy

Question 1

What is cervical excitation

Answer 1

When try to move cervix to either side of ectopic causes pain

Question 2

Risk factors for HPTN in pregnancy

Answer 2

Nulli-parous
Multiple pregnancy
Molar pregnancy
Diabetes
Renal disease
HPTN
Black ethnicity
Young or older patients

Question 3

Cercical shock

Answer 3

If cervical dilation parasympathetic innervation - symptoms of shock
Can happen in any proedure to cervix - cils, ERPOC, hysterectomy

Question 4

Symptoms POC

Answer 4

Blood supply

Question 5

Symptoms of PET

Answer 5

Headache, visual disturbances, nausea, vomiting, epigstric pain, restlessness, decreased urine output, oedema. Abdominal pain, bleeding/ leaking per vaginum, contractions, decreased fetal movements

Question 6

Normal size for the uterus

Answer 6

7.6cm x 4.5cm x 3cm

Question 7

What is recurrnet miscarriage

Answer 7

> 3 miscarriages one after the other in the same couple

Question 8

Examination for HPTN in pregnancy

Answer 8

MEWS
BP
urine protein on dipstick
General exam, tenderness in abdomen, reflexes
Urine dips stick/MSU/PCR
FBC, U&E, LFT Clotting, G&S.

Question 9

What do in abdo exam

Answer 9

Fundal height
Lie
Presentation
Abdo or uterine tenderness
CTG

Question 10

Management plan for woman with BP 155/100 and protein uria ++

Answer 10

Admit In antenatal ward and observe for 24 hrs if raised BP and proteinuria .
Monitor BP, urine output, biochemistry
fetal growth and well being.
Steroids for fetal lung maturity if delivery is considered within 7 days.
Oral anti-hypertensive -labetolol/methyl-dopa /nifedipine.

Question 11

What do if develope headahce and epigastric pain in pregnant woman?

Answer 11

Urgent review in ANW within 24 hours

Question 12

Features of severe pre-eclampsia

Answer 12

BP > 160/110
MAP >25
Hyperreflexia
Rt hypochrondrium tenderness
Uterus relaxed CTG normal

Question 13

Biochemistry of severe pre eclampsia

Answer 13

Raised urea >7
Creatinine - 80
ALT - 70
PLatelets 130
HELLP - haemolysis, elevated liver enzymes, low platelts

Question 14

What would expect from beta HCG if miscarriage

Answer 14

Half in 48 hours

Question 15

Management of severe pre-eclampsia

Answer 15

1-Needs intensive monitoring-Transfer to labour ward
2-Close monitoring BP, Urine output, bloods for Hb, platelets, urea,
creatnine, electrolytes, liver enzymes, clotting profile,
3-Urine protein -PCR

4- control BP –intravenous anti-hypertensives, labetolol, hydralazine
5- prevent- eclampsia magnesium sulphate
6- Delivery will be expedited IOL/Caesarean section
7-Fluid restriction to prevent pulmonary oedema

Question 16

When does beta HCG stop doubling

Answer 16

around 12 weeks

Question 17

When can see foetus on scan

Answer 17

6-7 weeks

Question 18

Pathology of pre-eclampsia

Answer 18

Cerebral- auto regulation of cerebral blood flow is disturbed
irritation, oedema, cerebral haemorrhage,
Eyes- retinal detachment, cortical blindness
Headache, visual disturbances, hyper-reflexia,scizures,coma ,
Lungs-Aspiration during eclamptic fit, hypoproteinaemia,reduced colloid oncotic pressures, intravenous crystalloid replacement for blood losses –prone to pulmonary oedema
Cardiac-contracted intravascular volume, generalised vasoconstriction, capillary leak and other reasons-avoid diuretics
Kidney-glomeruloendotheliosis-swelling of capillaries –decreased perfusion and GFR, loss of resistance to angiotensin II.
Liver- HELLP,congestion, sub capsular haemorrhage-hepatic rupture
( haemolysis, elevated liver enzymes, low platelets-)
Haematology- Anaemia, Disseminated intravascular coagulation
Placenta abruption/ intrauterine death

Question 19

Name 3 causes of increased symphyseal fundal height

Answer 19

Macrosomia, polyhydraminos, high BMI, fibroid uterus

Question 20

Name 3 causes of reduced symphysis fundal height

Answer 20

IUGR, oligohydraminos, transverse lie

Question 21

Pregnancy of unknown location (PUL)

Answer 21

When rigth bHCG for pregnancy
no foetus in uterus

Question 22

What is macrosomia?

Answer 22

large for gestational age

Question 23

Causes of oblique/transverse lie at term

Answer 23

Placenta previa, lower segmenet fibroid, cephalopelvic disproportion