Hypertension in Pregnancy

Question 1

define

Answer 1

BP of 140/90mmHg or more on 2 occasions or 160/110 once or if raised >30/15 since 1st trimester

Question 2

types of hypertension in pregnancy

Answer 2

pre-existing
pregnancy induced hypertension (PIH)
pre-eclampsia

Question 3

when does PIH happen?

Answer 3

2nd half of pregnancy

Question 4

when should PIH resolve?

Answer 4

within 6 weeks of delivery

Question 5

how do you distinguish PIH from pre-eclampsia?

Answer 5

proteinuria

oedema

Question 6

what is pre-eclampsia?

Answer 6

diffuse vascular endothelial dysfunction with widespread circulatory disturbance

Question 7

classification of pre-eclampsia

Answer 7

1. early= <34 weeks

2. late = >34 weeks

Question 8

causes of pre-eclampsia

Answer 8

genetics
environment
damaged placenta releases factors into the circulation that causes PET

Question 9

systemic presentations of pre–eclampsia

Answer 9

• liver disease (HELLP syndrome)

- placental disease

Question 10

presentation of HELLP syndrome

Answer 10

haemolysis
elevated liver enzymes
low platelets

Question 11

presentation of placental disease

Answer 11

headache
visual disturbance
RUQ pain
N&V

Question 12

risks with placental disease

Answer 12

FGR
placental abruption
intrauterine death

Question 13

cerebral irritation in PET

Answer 13

confused
can’t sit still
brisk reflexes

Question 14

management options for hypertension in pregnancy

Answer 14

methyldopa
labetolol
nifedipine
hydralazine
doxazocin

Question 15

action of methyldopa

Answer 15

alpha agonist

Question 16

when to avoid methyldopa?

Answer 16

depression

Question 17

mechanism of action of labetolol

Answer 17

alpha and beta antagonist

Question 18

when is labetolol contraindicated?

Answer 18

asthma

Question 19

action of nifedipine

Answer 19

Ca channel antagonist

Question 20

BP aim

Answer 20

130/85 (don’t be too aggressive)

Question 21

action of hydralazine

Answer 21

vasodilator

Question 22

mechanism of action of doxazocin

Answer 22

alpha antagonist

Question 23

when should doxazocin be avoided?

Answer 23

breastfeeding

Question 24

management of placental disease

Answer 24

low dose aspirin commencing before 16 weeks at 150mg

Question 25

what to avoid in labour if hypertension?

Answer 25

ergometrine as raises BP

avoid diuretics and ACEI

Question 26

what is eclampsia?

Answer 26

tonic-clonic seizure occuring with features of pre-eclampsia

Question 27

who is eclampsia more common in?

Answer 27

teenagers

Question 28

management of eclampsia

Answer 28

control BP= IV labetolol
stop seizure= magnesium sulphate IV
fluid restriction if pulmonary oedema
deliver baby