Hypertensive Disorders

Question 1

How can you qualify for the diagosis of superimposed preeclampsia?

Answer 1

New onset proteinuria >300mg (without proteinuria)
OR
A sudden increase in proteinuria or hypertension OR
Platelets Increased AST or ALT >70

Question 2

What’s the proper way to assess BP?

Answer 2

Cuff 1.5x upper arm circumference with bladder that encircles >80% of the arm
Arm at the level of the woman’s heart
Patient seated, at rest

Question 3

Maximum dose of Labetalol (current first line therapy for HTN in pregnancy)

Answer 3

1200mg/day

Question 4

Max dose of Nifedipine?

Answer 4

120 mg/day

Question 5

What very rare reaction has been reported when Ca-channel blockers and magnesium are combined, and how is it reversed?

Answer 5

Neuromuscular blockade (reversed with calcium gluconate)

Question 6

Conditions associated with previable HELLP

Answer 6

partial mole/triploidy
trisomy 13
antiphospholipid syndrome
autoantibodies to angiotensin AT(1)- receptor
severe preterm preeclampsia with “mirror” syndrome

Question 7

Benefits of magnesium for preeclampsia, compared to placebo

Answer 7

59% reduction in the risk of eclampsia (number needed to treat for an additional beneficial outcome: 100)
36% reduction in abruption, and nonstatistically significant but clinically important 46% reduction in maternal death.

Question 8

Benefits of dexamethasone for HELLP

Answer 8

no difference in the risk of maternal death, maternal death or severe maternal morbidity, or perinatal/infant death. The only significant effect of treatment on individual outcomes is improved platelet count: This effect is strongest if the treatment is started antenatally.