OBS: Maternal Medicine -- Hypertensive Disorders

Question 1

Risk factors for PET

Answer 1

• AMA + nulliparity / >10 year from last pregnancy / first pregnancy with new partner
• Pre-existing medical diseases:
  
  • HT, DM, Renal diseases
  • APS
  • Overweight
• Obstetrics Hx:
  
  • Hx of PET
  • Multiple pregnancy

Question 2

Assessments and investigations for mother with PET after admission for labour

Answer 2

• Monitor vitals: BP/P Q15mins, urine output Q1H
• Look for s/s: neurological s/s (convulsions, hyperreflexia), epigastric tenderness, pulmonary edema
• Investigations: (PET blood)
  
  • CBC for thrombocytopenia
  • Clotting profile for DIC
  • Cross match
  • LFT for bilirubin
  • RFT for creatinine, urate
• Fetal wellbeing:
  
  • Continuous CTG
  • USG for fetal growth, UmA doppler

Question 3

Management of eclampsia after convulsion subsides

Answer 3

• Monitor for neurological s/s Q1H
• CT brain to r/o ICH
• 4g IV MgSO4 loading over 5 mins → 1g / hour infusion for >=24h after last convulsion / delivery
• Monitor for urine output, patellar reflex, RR, SaO2 Q1H

Question 4

What is primary prevention? How is it done?

Answer 4

Prevention of disease before it occurs, by optimizing its modifiable risk factors

Question 5

How is primary prevention applied to pre-eclampsia?

Answer 5

• Frist-trimester pre-eclampsia screening:
  
  • based on maternal risk factors, maternal BP, UtA PI, PIGF
  • aspirin prophylaxis (150 mg nocte) for high-risk women until 36w
• Lifestyle modification of diet & exercise to lower BMI
• Optimise GDM control

Question 6

Physical signs of pre-eclampsia to look for besides BP & proteinuria

Answer 6

• Neurological (impending spre-eclampsia): hyperreflexia, ankle clonus, visual disturbance
• Hepatic: epigastric tenderness
• Renal: oliguria

Question 7

Acute management of eclampsia

Answer 7

• Call for help
• Resuscitation:
  
  • lie lateral to avoid aspiration pneumonia
  • ensure adequate oxygen supply: maintain airway, oxygenation +/- intubation
• MgSO4: loading 4g IV over 5 mins + 1 g/h for >=24h postpartum or after last convulsion

Question 8

Difference between resuscitating a pregnant women under cardiac arrest, and a non-pregnant adult

Answer 8

• Modify CPR by lateral uterine displacement
• Perimortem CS if no response for >4 mins, continue CPR during the procedure

Question 9

Factors to predict cerebral palsy of baby

Answer 9

• low APGAR score
• low umbilical pH

Question 10

Specific neonatal management to lower risk of cerebral palsy

Answer 10

Hypothermic therapy

Question 11

Further investigations for repeated convulsions

Answer 11

CT/MRI brain for intracranial haemorrhage