Maternal hypertension

Question 1

maternal hypertension categories

Answer 1

1. Pre existent hypertension - hypertension diagnosed in first trimester is not due to pregnancy 2. Hypertension during pregnancy w/o proteinuria - hypertension diagnosed in the second half of pregnancy 3. Pre eclampsia - hypertension in second half of pregnancy and protein in the urine

Question 2

Pre existing hypertension

Answer 2

1. risk factors for prexisting hpt - diabetes/renal disease/medical disorders - increased maternal age - family history 2. Women w/o medical conditions presenting w hpt ( secondary causes ) - aortic coarction - pheochromocytoma - cushings disease

Question 3

Pregnancy induced hypertension

Answer 3

1. resolves within 6 weeks of delivery 2. occurs at the second stage of pregnancy

Question 4

Risk factors of hypertension in pregnancy

Answer 4

1. Maternal - increased risk of cerebral haemorrhage if bp > 125 mmhg 2. Fetal - hypertension within placental vessels compromises fetal exchange and nutrition resulting in fetal growth restriction. 3. Increased risk of developing pre eclampsia

Question 5

Management of hypertension in pregnancy

Answer 5

1. If already pre hypertension then diet modifications and modifications of medications during pregnancy 2. Anti hypertensive medication - reduce the risk of cerebral haemorrhage 3. Uterine doppler ultrasound - blood flow of the uterine and placental arteries monitored thus 4. BP and urine must be checked for preclampsia 5. Growth scans - arranged to monitor fetal growth

Question 6

Pre eclampsia

Answer 6

1. Abnormal vascular response to pregnancy - physiologically in normal pregnancy the vascular resistance drops and there is hypotension 2. In pre eclampsia - lack of drop in peripheral resistance, thus there is hypertension and haemoconcentration

Question 7

End organ effects of pre eclampsia

Answer 7

1. Increased cerebral vascular resistance -> increased cerebral haemorrhages 2. Kidneys - glomerular capillaries leaky -> proteinuria 3. High resistant placental vessels - abnormal doppler ultrasound - lack of perfusion - oligohydrominos and IUGR 4. Liver - peripheral haemorrhagic necrosis - increase in ALT/AST

Question 8

Management of pre eclampsia

Answer 8

1. Treat high blood pressure in pre eclampsia with anti hypertensives 2. Only treatment for hypertension is delivery of the foetus

Question 9

Complications of pre eclampsia

Answer 9

1. Eclampsia 2. Hepatic rupture 3. HELLP - hemolysis, elevated liver enzymes and low platelets 4. Cerebral haemorrhage 5. DIC 6. PE

Question 10

Eclampsia

Answer 10

fitting or seizures secondary to pre eclampsia - happens mainly postnatally within 48 hours of delivery - differentials : epilepsy / meningitis

Question 11

Management of eclampsia

Answer 11

1. ABC 2. Magnesium sulphate - intravenously for convulsions 3. Hydralazine/labetolol - intravenously for blood pressure * all treatment should continue 24 hours after last seizure or delivery*

Question 12

treatment for hypertension in pregnancy

Answer 12

1. Methydopa - most effective and safe for pregnancy 2 Labetalol - beta blocker 3. Calcium antagonist - nifedipine 4. Hydralazine - IV infusion only 5. ACE inhibitors conta indic - fetal renal failure in pregancy