Hypertension in Pregnancy

Question 1

what happens to blood pressure in pregnancy

Answer 1

• falls in early pregnancy
• reaches plateau at 22-24 weeks
• rises until term

Question 2

what happens to bp after delivery

Answer 2

BP falls after delivery but subsequently times and peaks, at day 3-4 P/N

Question 3

what is the common BP after first trimester

Answer 3

100/80 or 90/60

Question 4

what cause decrease in BP in early pregnancy

Answer 4

reduced TPR caused by vasodilation

Question 5

at what point in the pregnancy should normal bp return

Answer 5

34 weeks

Question 6

what is the definition of HTN in pregnancy

Answer 6

≥140/90 mmHg on 2 occasions

OR

DBP > 110mmHg

OR

> 30/15mmHg increase compared to booking BP

Question 7

what risks do pre-existing HTN carry in pregnancy

Answer 7

Pre-eclampsia
IUGR
abruption

Question 8

what are features of PIH

Answer 8

disease of the second half of pregnancy

resolves within 6 weeks of delivery

No proteinuria/oedema or other features of pre-eclampsia

Question 9

what are features of pre-eclampsia

Answer 9

Hypertension

Proteinuria (≥0.3g/l or ≥0.3g/24h)

Oedema

Question 10

what is the pathogenesis of pre-eclampsia

Answer 10

Failure of trophoblast invasion reducing blood flow to placenta, as there is decreased placental perfusion, Mother raises blood pressure to compensate

Question 11

how can pre eclampsia affect the resp system

Answer 11

Pulmonary oedema&raquo_space; ARDS

Pulmonary Embolus

Question 12

how can pre eclampsia affect the placenta

Answer 12

IUGR
placental abruption
intrauterine death

Question 13

Sx of pre-eclampsia

Answer 13

headache
visual disturbances
epigastric/RUQ pain
Nausea/vomiting 
rapidly progressive oedema

Question 14

risk factors for pre-eclampsia

Answer 14

Maternal Age >40 years
Maternal BMI >30 
Family History 
Parity (first pregnancy)
Multiple pregnancy (Twins)
Previous PET 
Molar Pregnancy / Triploid

Question 15

what is the most significant risk factor for developing pre-eclampsia

Answer 15

having previously had pre-eclampsia

Question 16

what are medical risk factors for developing pre-eclampsia

Answer 16

Pre-existing renal disease
Pre-existing hypertension
Diabetes Mellitus
Connective Tissue Disease
Thrombophilias

Question 17

when should a mother be admitted

Answer 17

BP >170/110 or >140/90 with (++) proteinuria

significant symptoms; headache/visual disturbance/abdominal pain

abnormal biochemistry

significant proteinuria

need for antihypertensive therapy

signs of metal compromise

Question 18

what BP makes Tx needed

Answer 18

> 150/100

[>170 required immediate Tx]

Question 19

what drugs need to be avoided in the Tx of HTN in pregnancy

Answer 19

diuretics

ACE inhibitors

Question 20

what drugs can be used in Tx of HTN

Answer 20

methyldopa
labetolol
nifedipine

Question 21

what drug is contraindicated in depression

Answer 21

methyldopa

Question 22

what drug is contraindicated in asthma

Answer 22

labetolol

Question 23

what is eclampsia

Answer 23

Tonic-clonic seizure occuring with features of pre-eclampsia

Question 24

what age group is eclampsia more common in

Answer 24

teenagers

Question 25

Tx of eclampsia

Answer 25

antihypertensives
= IV Labetolol and/or Hydralazine

seizure
= IV Magnesium sulphate

Question 26

what is the dose of magnesium sulphate

Answer 26

4g IV over 5 minutes

Question 27

what are high risk women of developing pre eclampsia

Answer 27

Renal, DM, APS, Multiple risk factors, previous PET

Question 28

what can be given in high risk women to try prevent pre eclampsia

Answer 28

75mg aspirin