Hypertension in pregnancy

Question 1

blood pressure is proportional t systemic vascular resistance and cardiac output

Answer 1

blood pressure falls in second trimester

Question 2

when is nadir reached?

Answer 2

22-24 weeks

Question 3

after nadir, what happens?

Answer 3

steady rise until term

Question 4

after delivery what happens to blood pressure?

Answer 4

falls but then subsequently rises and peaks around day 3/4

Question 5

hypertension. what does bp have to be over on 2 occasions?

Answer 5

140/90
DBP >110
or >30/15 compared to booking visit

Question 6

what 2 factors makes HTN likey to be pre exising?

Answer 6

if its before 20 weeks gestation, or BP has not returned to normal within 3 months of delivery

Question 7

pregnancy induced hypertension, how long does it take to resolve

Answer 7

6 weeks

Question 8

15% of gestational hypertension go on to ?

Answer 8

pre eclampsia

Question 9

3 things in pre eclampsia?

Answer 9

hypertension, proteinuria (>0.3g/l), oedema. lack of oedema doesn’t exclude diagnosis

Question 10

pre eclampsia risk factors?

Answer 10

1st child, obesity, history, diabetes, obesity, kidney disease

Question 11

buz diffuse vascular endothelial dysfunction

Answer 11

pathogenesis - abnormal formation of placenta and trophoblast invasion. failure of vascular remodelling

Question 12

2 stages of pre eclampsia?

Answer 12

stage 1 - abnormal placental perfusion

2 - maternal syndrome

Question 13

pre eclampsia is a multi system disorder** it affects…

Answer 13

CNS, renal, hepatic, haematological, cardio, placental

Question 14

symptoms of pre eclampsia?

Answer 14

headache, visual disturbance, epigastric RUQ pain, nausea, vomiting, rapidly progressive oedema

Question 15

3 main signs?

Answer 15

hypertension, proteinuria, oedema

Question 16

risk factors?

Answer 16

family history, history, obesity, first child, over 40, obese, diabetes,CKD, connective tissue disease, thrombophilia

Question 17

when to admit?

Answer 17

BP>170/110 or >140/190 with proteinuria

Question 18

significant symptoms - headache visual disturbance, abdominal pain

Answer 18

abnoral biochemistry

Question 19

proteinuria (jd)

Answer 19

need for antihypertensive therapy (gr)

Question 20

signs of fetal compromise

Answer 20

Inpatient assessment - blood pressure 4 hourly, urinalysis,, input/output, UPCR, bloods - minimum 2 per week

Question 21

with an MAP of over 150, there is a significant risk of cerebral haemorrhage

Answer 21

y

Question 22

how do you calculate MAP?

Answer 22

2d + s / 3

Question 23

control of blood pressure DOES NOT reduce the risk of pre eclampsia

Answer 23

.

Question 24

what class of drug is nifedipine?

Answer 24

calcium channel blocker

Question 25

labetalol?

Answer 25

alpha and beta blocker

Question 26

who can you not give labetalol to?

Answer 26

asthmatic patients

Question 27

methyl dopa - what class of drug?

Answer 27

alpha agonist

Question 28

who can you not give metal dopa to?

Answer 28

patients with depression

Question 29

hydralazine?

Answer 29

vasoconstrictor

Question 30

what do steroids promote?

Answer 30

fetal lung surfactant production

Question 31

steroids reduce RDS by 50% if administered 24-48 hours before delivery

Answer 31

can administer up to 36 weeks

Question 32

what steroid would you use?

Answer 32

betamethasone

Question 33

tonic clonic seizure occurring with features of pre eclampsia?

Answer 33

eclampsia

Question 34

who is eclampsia more common in?

Answer 34

teenagers

Question 35

management?

Answer 35

control blood pressure, stop seizures, fluid balance, delivery

Question 36

what do you use to control blood pressure?

Answer 36

IV LOL HI IV labetalol, hydralazine

Question 37

prophylaxis/seizure treatment?

Answer 37

magnesium sulphate

Question 38

if persistent consider?

Answer 38

diazapam

Question 39

main cause of death from pre eclampsia?

Answer 39

pulmonary oedema

Question 40

what is used to prevent seizures in women with pre eclampsia?

Answer 40

magnesium sulphate

Question 41

what does aspirin inhibit?

Answer 41

COX

Question 42

what pathway is COX involved in?

Answer 42

production of TXA2

Question 43

when would you commence aspirin treatment in a high risk patient?

Answer 43

before 12 weeks

Question 44

placental ischaemia leads to widespread endothelial damage and dysfunction

Answer 44

.

Question 45

what happens to spiral arteries?

Answer 45

fail to adapt to become high capacitance, low resistance vesslels.

Question 46

lack of blood to placenta leads to

Answer 46

oxidative stress. PGI2:TXA2 imbalance.

Question 47

get endothelial activation. increased permeability, expression CAM, prothrombotic factors, platelet aggregation, vasoconstriction

Answer 47

.