Hypertensive disease of Pregnancy

Question 1

What are the different causes of hypertensive pregenancies?

Answer 1

Pregnancy induced hypertension -PIH
Pre-Eclampsia
Eclampsia
HELLP Syndrome

Question 2

What is the definition of pregnancy induced hypertension?

Answer 2

New onset hypertension developing after 20 weeks gestation

Question 3

What is the difference between Pre-eclampsia and Eclampsia

Answer 3

New onset hypertension developing after 20 week gestation w/:

Pre-eclampsia - Proteinuria
Eclampsia - Proteinuria & Seizures

Question 4

Pregnancy induced hypertension Sx

Answer 4

Usually Asx
headache / blurred vision

Question 4

Pre-eclampsia / Eclampsia Sx

Answer 4

 Raised blood pressure
 Protein in urine
 Headache
 Swollen hands, feet or face
 Visual disturbances i.e. blurred vision or flashing lights
 Upper abdominal pain or rib pain
 Feeling unwell

+
Seizures if Eclampsia

Question 5

Investigating pregnancy HTN

Answer 5

Blood pressure measurements
Urinalysis
sFLT : PIGF ratio (>85 is diagnostic)

Question 6

What further investigation should be done

Answer 6

Bloods: FBC, UE, LFT - (Twice weekly)
US- foteal growth and amniotic fluid index
umbilical artery doppler
Cardiotocography

Question 7

Whats sFLT : PlGF ratio (>85 is diagnostic) ?

Answer 7

sFLT-1 (soluble fms-like tyrosine kinase-1): This is an anti-angiogenic factor that inhibits the activity of vascular endothelial growth factors (VEGF) and PlGF. It is elevated in cases of pre-eclampsia.

PlGF (Placental Growth Factor): PlGF is a pro-angiogenic factor involved in placental development and blood vessel formation. Levels of PlGF decrease in pre-eclampsia

A high sFLT-1: PlGF ratio (typically >85 in early-onset cases and >38 in late-onset pre-eclampsia) suggests a higher risk or presence of pre-eclampsia.

Question 8

managing hypertension during prgenancy

Answer 8

PREVENTION: Aspirin OD

1st line: Labetalol (bb)
2nd line: Nifedipine
3rd line- Methyldopa

consider early delievery

Question 9

Complication of hypertensive pregnancies

Answer 9

Eclampsia - Tonic clonic Seizures + Preeclampsia

HELLP SYNROME - Haemolysis, ELvated Liver Enzymes, Low Platletets

Placental abruption
DIC

Question 10

How to manage eclampsia

Answer 10

IV MgSo4
C section

Question 11

how to managage HELLP sydnrome

Answer 11

Iv MgSo4
C sextion

Question 12

diagnostic criteria for severe pre-eclampsia - requiring ADMISSION

Answer 12

1. Systolic BP>160mmhg/l
2. Severe headache
   Visual scotomata (blind spots)
   N/V
   Oliguria
   Epigastric Pain
   Pulmonary Odema
3. RIsing creatinine, Elevated LFTs, Thrombocytopenia

Question 13

Describe some pathophysilogical processes associated with pre-eclampsia?

Answer 13

Increased pro-inflammatory cytokines by stressed trophoblasts - increased oxidative stress

Impaired renal blood flow = reduced eGFR