Hypertension In Pregnancy

Question 1

What happens to the blood volume during pregnancy?

Answer 1

Increases 30%

Question 2

Plasma volume decreases during pregnancy, true/false?

Answer 2

False

Increases 45%

Question 3

What happens to cardiac output during pregnancy

Answer 3

Increases 30-50%

Question 4

By what % does stroke volume change during pregnancy?

Answer 4

Increases 25%

Question 5

During pregnancy does peripheral vascular resistance increase or decrease?

Answer 5

Decreases 15-20%

Question 6

What happens to the CVP during pregnancy?

Answer 6

Nothing it remains unchanged

Question 7

Why does BP increase during pregnancy?

Answer 7

Peripheral vascular resistance decreases due to increased vasodilation

Question 8

How is hypertension diagnosed?

Answer 8

> 140/90 mmHg on two occasions
OR
160/110 mmHg once

Question 9

During their pregnancy, when are women most likely to develop pregnancy induced hypertension?

Answer 9

During second trimester

Question 10

What is the risk of PIH becoming pre-eclampsia?

Answer 10

15%

Question 11

Rate of recurring hypertension in pregnancy is common? True/False

Answer 11

True

Rate of recurrence is high

Question 12

What three features found together lead to a diagnosis of pre-eclampsia?

Answer 12

Hypertension
Proteinuria
Oedema

Question 13

When do the majority of pre-eclampsia patients present?

Answer 13

> 34 weeks gestation

Question 14

What risks are associated with early pre-eclampsia?

Answer 14

Extensive villous and vascular lesions of placenta

Higher risk of maternal and foetal complications

Question 15

Define pre-eclampsia

Answer 15

A pregnancy-specific multi-system disorder with unpredictable, variable and widespread manifestations ​

Question 16

What three placental problems can occur in pre-eclampsia?

Answer 16

Restricted foetal growth
Placental Abruption
Intra-uterine death

Question 17

List three CNS complications of pre-eclampsia?

Answer 17

Intracranial hemorrhage
Hypertensive encephalopathy
Cerebral oedema

Question 18

What is HELLP syndrome?

Answer 18

This is a complication of pre-eclampsia consisting of

Haemolysis, Elevated Liver enzymes, Low Platelets

Question 19

List three hematological complications of pre-eclampsia?

Answer 19

Decreased plasma volume
Thrombocytopenia
Haemolysis

Question 20

Give three renal complications of pre-eclampsia?

Answer 20

Decreased eGFR
Proteinuria
Acute renal failure

Question 21

What two pulmonary complications can result from pre-eclampsia

Answer 21

Pulmonary Oedema

Pulmonary Embolism

Question 22

List five symptoms of pre-eclampsia

Answer 22

Headaches
Visual disturbance
Nausea/Vomiting
Rapid oedema 
RUQ/Epigastric pain

Question 23

List 4 signs of pre-eclampsia (not the 3 diagnostic features)

Answer 23

Abdominal tenderness
Disorientation
Small for gestational age
Hyper-reflexia / clonus

Question 24

What investigations are carried out for pre-eclampsia?

Answer 24

Us and Es 
Serum Urate
LFTs
FBC
Coagulation Screen
Urine PCR
CTG
Ultrasound

Question 25

When would you admit a woman with pre-eclampsia?

Answer 25

BP >170/110 or 140/90 with proteinuria Significant symptoms or proteinuria (>300mg/24h) Abnormal biochemistry Signs of fetal compromise

Question 26

What medications are first line for hypertension management in pregnancy?

Answer 26

Labetolol Methydopa Nifedipine (less used)

Question 27

What 2 medications are second line for management of hypertension in pregnancy?

Answer 27

Hydralazine Doxazocin

Question 28

Most women with pre-eclampsia deliver within 4 weeks of diagnosis. True/False

Answer 28

False They deliver within two weeks

Question 29

Define Eclampsia

Answer 29

Tonic-clonic (grand mal) seizure occurring with features of pre-eclampsia

Question 30

In what age group is eclampsia most common?

Answer 30

Teenagers

Question 31

What is the only cure for pre-eclampsia?

Answer 31

Delivery of baby

Question 32

When should foetus be delivered in pre-eclampsia?

Answer 32

``` If pregnancy at term Unable to control BP Eclampsia Foetal Compromise Rapid deterioration of biochemistry/haematology ```

Question 33

What proportion of women will suffer eclampsia seizure without onset of hypertension or proteinuria

Answer 33

>1/3rd

Question 34

What medication is given to manage eclampsia seizures?

Answer 34

Magnesium Sulfate IV | 4g in 5 minutes loading dose

Question 35

What can be given is patient continues to seizure?

Answer 35

Diazepam

Question 36

What must you be careful of when monitoring patient pre and during labour with pre-eclampsia?

Answer 36

Fluid balance Oedema from overload is commonest cause of maternal death