Module 6 : Hypertension in Pregnancy

Question 1

what is chronic or essential hypertension

Answer 1

• hypertension discovered before pregnancy or before 20 weeks

Question 2

what are the secondary causes of hypertension in pregnancy when hypertension is seen before pregnancy

Answer 2

• renal disease
• endocrine disorders
• neurologic disorders

Question 3

what is gestational hypertension

Answer 3

• occurs after 20 weeks
• blood pressure above 140/90mmHg
• some patients are asymptomatic
• no presence of proteinuria

Question 4

what can gestational hypertension lead to

Answer 4

• pre eclampsia

Question 5

when does gestational hypertension usually resolve

Answer 5

• within first 12 weeks of giving birth

Question 6

what is pre eclampsia caused by

Answer 6

• caused by prostaglandin abnormalities

Question 7

what are prostaglandins

Answer 7

• the contraction and relaxation of smooth muscles
• the dilation and constriction of blood vessels
• control of blood pressure
• modulation of inflammation

Question 8

why does pre eclampsia occur

Answer 8

• abnormal development of the blood vessels of the placenta early in pregnancy
• trophoblast does not invade the decidua properly and spiral arteries remain small and rigid so not enough flow tot eh fetus and the oxygen supply to fetus reduced

Question 9

when does pre eclampsia occur

Answer 9

• after 20 weeks

Question 10

what are the symptoms fo pre eclampsia

Answer 10

• blood pressure above 140/90
• proteinuria
• edema
• rapid wait gain

Question 11

what must occur in order for pre eclampsia to be diagnosed

Answer 11

• high blood pressure present with one or more of the other symptoms

Question 12

what resolves pre eclampsia

Answer 12

• delivery

Question 13

what does HELLP stand for

Answer 13

Hemolysis
Elevated Liver enzymes
Low Platelets

Question 14

what is HELLP syndrome

Answer 14

• a severe variant of of pre eclampsia
  + maternal hypertension
  + edema
  + abdominal pain due to hepatic hemorrhage

Question 15

what is eclampsia

Answer 15

• onset of seizures in a women with pre eclampsia

Question 16

what are the characteristics of eclampsia

Answer 16

• seizures
• coma
• bleedong
• headaches
• blurred vision
• maternal death
• fetal death

Question 17

what is the sonography role in hypertension

Answer 17

• IUR
• preterm layer
• placental abruption
• placental infarcts
• oligohydramnios
• decreased placental maturation
• fetal demise

Question 18

what low level of first trimester screen test is considered a marker for pre eclampsia

Answer 18

• PAPP A

Question 19

what doppler test is used to screen for women at an increased or high risk for pre eclampsia

Answer 19

• doppler indicies for the uterine artery

Question 20

what are the abnormal findings of the uterine artery dopplers

Answer 20

• increased resistance to blood flow
• resistance should fall with advancing gestation so high resistance indicates increased vascular resistance and poor uterine circulation

Question 21

what is the proper protocol for hypertension in pregnancy

Answer 21

• BPP
• growth
• doppler of umbilical artery

Question 22

what does the doppler look like in the umbilical artery with hypertension

Answer 22

• high resistance
• low or reversed diastolic flow
• PI preferred measurement

Question 23

what does doppler look like in the MCA with hypertension

Answer 23

• low resistance

- increased diastolic flow

Question 24

what does the doppler look like int eh ductus venosus with hypertension

Answer 24

• reversal during atrial contraction

Question 25

what is the treatment for hypertension

Answer 25

• bed rest
• medication for hypertension
• increased monitoring of mother and fetus
• delivery is the only way to reverse the process