Hypertensive disease and pre-eclampsia

Question 1

What happens to BP in pregnancy?

Answer 1

• decreases over first 24 weeks (fall in SVR)

- increases weeks 24 to term due to increased SV.

Question 2

What is pregnancy induced hypertension defined as?

How is this treated?

Answer 2

• HTN >140/90 in the 2nd half of pregnancy in ABSENCE of proteinuria or other markers of pre-eclampsia
• Aim delivery for normal EDD
• labetalol, nifedipine or methyldopa

Question 3

When should a patient be admitted to hospital with PIH?

What should you do to manage mild-moderate HTN?

Answer 3

• BP 160/110 or higher
• USS measuring: foetal growth, amniotic fluid volume
• umbilical artery doppler velocimetry if diagnosis at <34 weeks
• CTG only necessary if abnormal foetal activity

Question 4

How do you monitor the foetus in severe PIH or pre-eclampsia?

Answer 4

• USS for foetal growth, amniotic fluid and umbilical artery doppler
• CTG

Question 5

What is thought to be the cause of pre-eclampsia?

Answer 5

• multi system disorder caused by endothelial cell damage of placenta
• exaggerated maternal response leads to vasospasm, increased capillary permeability and clotting dysfunction

Question 6

What is the physiological basis for the outcomes of pre/ eclampsia?

Answer 6

• increased vascular resistance: HTN
• increased permeability: proteinuria
• reduced placental perfusion: IUGR
• reduced cerebral perfusion: eclampsia

Question 7

risk factors for pre-eclampsia? (7)

Answer 7

• obesity (BMI >30)
• young or old age
• multiple pregnancy (x5)
• previous pregnancy (x7)
• hydatidiform mole
• foetal hydrops
• pre-existing medical conditions: HTN, renal disease, DM, antiphospholipid antibodies, thrombophilia, connective tissue disorder

Question 8

What are the symptoms of pre-eclampsia? (6)

Signs?

Answer 8

• asymptomatic usually
• headache
• drowsiness
• visual disturbance
• N & V/ epigastric pain (late stage)
• Hypertension
• massive oedema (facial)
• sudden onset

Question 9

How is pre-eclampsia diagnosed?

Answer 9

• proteinuria

- PCR (protein creatinine ratio) >30mg/mmol on urine test

Question 10

Who should be taking aspirin and when?

Answer 10

• from 12 weeks till birth
• women with hypertensive disease, CKD, autoimmune conditions
• DM

Question 11

You should take aspirin if you have more than one of:

Answer 11

• age >40
• BMI >35
• FH
• multiple pregnancy
• pregnancy interval >10 years

Question 12

How is eclampsia treated?

Answer 12

• magnesium sulphate

Question 13

What does HELLP syndrome involve?

Answer 13

• haemolysis
• Elevated Liver enzymes (ALT not really ALP)
• Low Platelets
• renal failure
• pulmonary oedema

Question 14

How should you manage pre-eclampsia before 34 weeks?

above 37 weeks?

post- partum?

Answer 14

• only offer birth if course of steroids have been given and HTN refectory to treatment
• 34-37 weeks: less threshold for brith
• 37 weeks: birth within 24-48 hours
• take BP 4x a day and monitor
• measure AST, platelets, creatinine