hypertension in pregnancy

Question 1

what is the definition of hypertension

Answer 1

a persistently elevated DBP of 90 mmHg or more observed on 2 occasions 4 hours apart
or a single reading of DBP 110mmHg or more

Question 2

how do we detect proteinuria?

Answer 2

dipstick tests: standard OPD method
sulphosalisylic acid test = cold test
24 hour urinary protein quantification

Question 3

how much protein is considered pathological

Answer 3

any more than 300mg in the urine over 24 hours

Question 4

list 5 other causes of proteinuria in pregnancy

Answer 4

contamination with vaginal discharge
urinary tract infection
renal disease
orthostatic proteinuria
GPH with or without hypertesion

Question 5

what are Daveyy and McGillvrays 3 categories of hypertension

Answer 5

gestational disease
chronic disease
unclassified disease

Question 6

which 4 disorders fall under gestational disease

Answer 6

GPH
latent essential hypertension
undiagnosed chronic hypertension
acute nephritis

Question 7

who is at risk for GPH

Answer 7

young primigravid women
newly parous women = paternal ab
parous women

Question 8

what is the pathophysiology of GPH

Answer 8

= failure of second wave trophoblast invasion leading to abnormal development of the spiral arterioles and under perfusion of the choriodecidual space. This leads to IUGR and mediates a second phase of the disease characterised by endothelial pertubation.
Hyperdynamic circulation in pregnancy –> increased vasospasm, falling stroke volume, multi organ ischaemia

Question 9

which 4 factors can trigger latent essential hpt

Answer 9

weight gain
salt intake
pregnancy

Question 10

when do patients with latent essential hpt present

Answer 10

In the second or third pregnancy often if they have a first degree relative who is hypertensive

Question 11

When does undiagnosed chronic hypertension present and why?

Answer 11

The physiologcal changes of pregnancy mask the high BP due to the apparent normotensive state. Therefore the patient will present in the late second trimester when BP begings to rise to pre pregnancy levels

Question 12

What would you find in the urine of a patient with acute nephritis?

Answer 12

haematuria

granular casts

Question 13

when does chronic hypertension present

Answer 13

after the 20th week

Question 14

what are the causes of chronic hypertension

Answer 14

essential hypertension
renal hypertension SLE, chronic GN
phaeochromocytoma
conns
cushings
coarctation
neurofibromatosis

Question 15

when do patients present with unclassified hypertension

Answer 15

for the first time after 20 weeks