Hypertension in pregnancy

Question 1

What is classified as mild, moderate and severe hypertension

Answer 1

mild - D 90-99 S 140-149, moderate - D 100-109 S 150-159, severe - D110+ S 160+

Question 2

Difference between gestational hypertension and preeclampsia

Answer 2

Both present with hypertension after 20 weeks gestation but preeclampsia has significant proteinuria

Question 3

testing for preeclampsia

Answer 3

Dip stick urine then a protein creatinine ratio is taken, about 30 is significant

Question 4

Eclampsia

Answer 4

Tonic clonic seizures associated

Question 5

4 blood pressure medications used in hypertension during pregnancy

Answer 5

Labetolol, methyldopa, nifedipine, IV hydralazine

Question 6

What is labetolol contraindicated in?

Answer 6

Asthma

Question 7

Symptoms of preeclampsia in eyes, respiratory system, liver, blood, CNS, kidneys, uteroplacental circulation

Answer 7

Papilloedema, retinal haemorrhage, pulmonary oedema, ARDS, Liver haemorrhage or rupture, HELLP syndrome, DIC, headache, seizures, CVA, AKI, IUGR, IUD, placental abruption

Question 8

What steroids are considered for a hypertensive mother with a pregnancy less than 34 weeks?

Answer 8

Beta methasone

Question 9

2 parental agents that can be given in hypertension

Answer 9

IV labetolol IV hydalazine

Question 10

What infusion is given is severe pre-eclampsia

Answer 10

IV 4g loading dose then 1g/hr slow mg sulfate

Question 11

What is antedote solution for Mg sulphate?

Answer 11

Calcium gluconate 10ml

Question 12

Women with previous eclampsia need to take what?

Answer 12

75mg Aspirin 12 weeks gestation to birth of baby

Question 13

4 endocrine causes of high BP?

Answer 13

Phaeochromocytoma, Conn’s syndrome, hyperthyroidism, Cushings syndrome

Question 14

5 causes of renal high BP?

Answer 14

glomerulonephritis, chronic pyelonephritis, diabetic nephropathy, polycystic kidney disease, lupus nephropathy

Question 15

4 tests needed for raised BP?

Answer 15

BP in both arms, U&E, AM and PM cortisol, TFTs

Question 16

If mother comes in with high BP what initial investigation do they need?

Answer 16

Dinamapp producing 30 minute constant reading (and proteinuria)

Question 17

Symptoms of preeclampsia for woman

Answer 17

blurred vision, blind, headache, confusion, dizzy, drowsy, hyper reflexive, generalised oedema, nausea, vomiting, RUQ pain, oliguria, anuria, haematuria

Question 18

7 sites to assess for oedema?

Answer 18

tibial, presacral, abdomen, retina, periorbital, conjunctival, fingers

Question 19

What does hydatidiform mole predispose to?

Answer 19

Hypertension

Question 20

What is the key difference in uterosacral circulation that leads to preeclampsia?

Answer 20

when the trophoblasts invade the spiral arteries, only the endometrial portion is invaded in preeclampsia and therefore less dilation, more resistance to blood flow and less perfusion

Question 21

What happens to thromboxane a in preeclampsia

Answer 21

increases

Question 22

How do you manage the fetus in preeclampsia?

Answer 22

US IUGR, doppler uterine artery, CTG daily

Question 23

Why is catheterisation important in preeclampsia management?

Answer 23

strict IO for urine creatinine clearance

Question 24

What do you do if preeclamptic patient had UO of less than 50ml/hour

Answer 24

daily UE and uric acid

Question 25

How is bethametasone administered?

Answer 25

2 doses of 12mg IM 24 hours apart

Question 26

Antidote to MgSO

Answer 26

Calcium gluconate 1g

Question 27

Monitoring requirements on MgSO4

Answer 27

tendon reflexes, RR, BP, UO, O2