Hypertension in Pregnancy

Question 1

Define gestational hypertension

Answer 1

New hypertension >20 weeks term

Question 2

Define pre-eclampsia

Answer 2

Characterised by new hypertension >20 weeks gestation + proteinuria in pregnancy

Question 3

Hypertension criteria in pre-eclampsia

Answer 3

> 140/>90mmHg

>4hrs apart

Question 4

What is the proteinuria criteria in pre-eclampsia

Answer 4

> 300mgms/24hrs

Protein:Creatinine ration >30mgms/mmol

Question 5

Define moderate hypertension in pregnancy

Answer 5

100-109/150-159

Question 6

Define mild hypertension in pregnancy

Answer 6

90-99/140-149

Question 7

Define severe hypertension in pregnancy

Answer 7

> 110/>160

Question 8

High risk risk factors for pre-eclampsia

Answer 8

Previous severe or early onset pre-eclampsia 
Chronic hypertension 
CKD 
DM 
Autoimmune disease

Question 9

Moderate risk risk factors for pre-eclampsia

Answer 9

1st pregnancy 
>40yrs
Pregnancy interval >10yr 
BMI>30 
FH pre-eclampsia 
Multiple pregnancy

Question 10

Signs of pre-eclampsia

Answer 10

Severe hypertension 
Proteinuria 
Epigastric or RUQ abdo. pain/tenderness 
Brisk reflexes 
Clonus 
Papilloedema

Question 11

Define eclampsia

Answer 11

Tonic-clonic seizures + pre-eclampsia

Question 12

Biochemical signs of pre-eclampsia

Answer 12

Increased liver enzymes 
Increased bilirubin 
Increased urea
Increased creatinine 
Increased urate

Question 13

Ix for pre-eclampsia

Answer 13

Frequent BP checks 
Urine protein (dipstick)
Protein:creatinine ratio
FBC 
LFTs
Renal function tests 
USS for fetal growth monitoring
CTG

Question 14

Rx for chronic hypertension in pregnancy

Answer 14

Pre-pregnancy care

Change anti-hypertensive drugs

Question 15

What are safe anti-hypertensive drugs in pregnancy

Answer 15

Lebetalol
Nifedipine
Methyldopa

Question 16

What is the problem with ACEi in pregnancy

Answer 16

They are teratogenic

Question 17

What is the definitive cure of pre-eclampsia

Answer 17

Delivery of the baby and the placenta

Question 18

If inducing labour what should be given to the foetus and what for

Answer 18

Corticosteroids for fetal lung development

Question 19

when do eclamptic females have seizures?

Answer 19

38% antenatally
18% intra-partum
44% postnatally

Question 20

Rx for eclampsia

Answer 20

ABCDE
Magnesium sulphate bolus + IV infusion (for seizure)
IV Labetelol
Monitor fetes using CTG

Question 21

Rx for seizures in eclampsia

Answer 21

Magnesium sulphate bolus + IV infusion

Question 22

Rx for BP control in eclampsia

Answer 22

IV Labetolol

Question 23

Clinical features of Eclampsia

Answer 23

Headache 
Hyper-reflexia 
Nausea
Vomiting 
Gastric pain 
Visual disturbances
Generalised oedema

Question 24

What is the prophylaxis for PET in subsequent pregnancies

Answer 24

Low dose aspirin from 12 weeks - delivery

Question 25

What is HELLP Syndrome characterised by

Answer 25

H (haemolysis) EL (elevated liver enzymes) LP (Low platelets)

Question 26

What does HELLP syndrome usually occur in association with

Answer 26

Pre-eclampsia

Question 27

Clinical features of HELLP syndrome

Answer 27

``` epigastric pain Hypertension Proteinuria Oedema Hepatomegaly Increased liver enzymes Decreased platelet count Nausea/Vomiting ```

Question 28

Fetal complications of PET

Answer 28

``` Impaired placental perfusion Small baby IUGR Fetal distress Prematurity Increased PN mortality ```