Hypertensive disorders

Question 1

commonest cause of death in preeclampsia

Answer 1

Intracranial Hemorrhage

Question 2

enzyems that decrease prediciting of PET

Answer 2

• major cardiovascular events
• Cardiovascular mortality
• HTN
• stroke

Question 3

placental biomarkers that if increase predict PET

Answer 3

1. Soluble fms-like tyrosine kinase 1 S-FLT1
2. Soluble Endoglin SEND
3. BHCG
4. FFDNA (relaesed by dead placental trophoblasts

Question 4

placental biomarkers that if decrease predict PET

Answer 4

1. Placental like Growth Factor PlGF
2. pregnancy associated plasma protein
3. vascular endothelial growth factor
4. ADAM 12

Question 5

when we do uterine artery doppler to predict PET

Answer 5

1st or 2nd trimester

Question 6

the most accurate test to predict PET

Answer 6

Uterine artery doppler (diastolic notch)

81% of women w/ early onset PET

Question 7

is Ca deficiency a risk factor for PET

Answer 7

yes

as it increases prothormone that increases intracellular calcium leading to vasocinstriction

Question 8

Recommended dose of VIT D for all pregnant women and PET

Answer 8

for all women: 400mcg/d
in PET: 800 mcg/d + Ca
in high risk of vit D deficiency: 1000 mcg

Question 9

when we give Calcium sup.

Answer 9

after 20 w

1.5-2 g elemental Calcium

Question 10

What is chronic HTN

Answer 10

HTN that presents before 20 w if the women already taking anti-HTN prior to pregnancy

Question 11

pregnancy care in chronic htn in pregnancy

Answer 11

-Stop ACEI, ARBs and theothiazides
- Encourage low Na diet
- Target BP 135/85

Question 12

Anti-hypetresive drugs safe in pregnancy

Answer 12

1st - Labetalol
2nd -Nifedipine
3rd - Methyldopa

Question 13

When to take Aspirin in case of HTN/PE

Answer 13

Aspirin 75-150mg/d from 12 weeks, if one of these:
- HTN during pvs preg.
- chronic kidney dis.
- Autimmune dis.
- DM type 1 or type 2
- Chronic HTN

or 2 of these:
- (1) 1st preg.
- (2) twins
- (10) preg. interval >10 y
- (35) BMI 35 kg/m2
- (40) >40 years
- family hx

Question 14

when to offer PIGF test to rule out PET

Answer 14

20 - 36+6 Weeks if women w/ CHTN suspected to have PET

Question 15

Antenatal Appointment in Chronic HTN

Answer 15

• if Well controlled: every 2-4 w
• if poor controlled: weekly

Question 16

postpartum manegement of CHTN

Answer 16

• BP daily 1st 2 days, then at least once from day 3 to 5
• keep BP less than 140/90
• review anti-htn durgs after 2 weeks of birth

Question 17

When to stop methyldopa after delivery and why

Answer 17

take it only for 2 days then return to preconception antihypertensive, as it causes PP depression

Question 18

CHTN

when to offer a medical review postpartum

Answer 18

6-8 weeks

Question 19

Proteinuria used to diagnose PET

Answer 19

• dipstick +1
• PCR >30 mg/mmol
  ACR> 8 mg/mmol

Question 20

Do mild/moderate/sever GHTN need admission

Answer 20

Mild/Moderate- outpatient
Severe- inpatient

Question 21

Measure BP in mild/moderate/sever GHTN

Answer 21

mild/moderate: once or twice weeks
sever: on monitor every 15-30 mins until BP <160/110

Question 22

Test for proteinuria in mild/moderate/sever GHTN

Answer 22

mild/moderate: once or twice with BP measurement
sever: daily while admitted

Question 23

when to do Blood test in mild/moderate/sever GHTN

Answer 23

CBC, livver enz., renal functions at presentation then weekly

Question 25

when to do U/S in mild/moderate/sever PET

Answer 25

mild/moderate: at diagnosis -> if normal every 2-4 w, if clincally indicated
sever: at diagnosis -> if normal every 2w, if clincally indicated

Question 26

Timing of birth in GHTN

Answer 26

After 37 w ->if bp <160/110 , w/ or w/o ttt
if refractory sever-> terminate after course of corticosteroids (if required) +/- MgSo4