Pre-eclampsia and gestational HTN

Question 1

Gestational HTN:

Over what BP is classed as HTN?

After what gestation is it classed as Gest HTN?

Answer 1

New-onset BP >140/90

After 20 wks gestation (5 months)

Question 2

Gestational HTN:

Management for BP >140/90:
- What needs to be checked weekly - 2

Management for BP >150/100:

• What needs to be prescribed?
• What needs to be checked twice a week - 2
• What bloods need to be done? - 3

Management for BP >160/110:

• What needs to be done to the patient asap?
• What needs to be prescribed?
• What needs to be checked 4 times a day?
• What bloods need to be done weekly? - 3

Answer 2

Check BP and proteinuria weekly

Anti HTN
Check BP and proteinuria twice a week
Bloods - FBC, U&E, LFTs

ADMIT THEM
Anti HTN
Check BP 4 times a day
Bloods - FBC, U&E, LFTs

Question 3

Gestational HTN:

Antihypertensive choice in pregnancy - L, N, H?

Fetal monitoring - types

Answer 3

Labetalol
Nifedipine
Methyldopa

Growth scan
Biophysical profile
Umbilical artery doppler
CTG if needed

Question 4

Gestational HTN:

Delivery:
- What gestation to deliver vaginally?
- What should be given to prepare the baby for delivery?
-

Answer 4

37 wks - minimum for term

Steroids

Question 5

PET:

2 components

Why does it happen?

What 3 organs does it affect?

What effect does it have on the blood?

Answer 5

Gest HTN + proteinuria

Disorder of placenta

Liver
Kidneys
Brain

Low platelets - thrombocytopenia - coagulation problems

Question 6

PET:

Uteroplacental dysfunction - how does this affect baby?

How can you see if blood flow to the baby is compromised?

After what gestation is PET diagnosed?

How long postpartum does it take to resolve?

How does it kill the mother?

What is the only way to resolve the issue?

Answer 6

Growth restriction
Stillbirth

Uterine artery doppler

20 wks

6 wks

Cerebral haemorrhage - due to high BP
Multi-organ failure - liver, kidneys etc.
ARDS - Acute respiratory distress syndrome

Delivering the baby

Question 7

PET:

What gestation does it usually occur in?

How long does it take for symptoms to present?

What does HTN before 20 wks suggest?

Answer 7

34-36 wks - (8-9 months)

As short at 48 hrs, but can be up to 6 wks

Pre-existing HTN that was never discovered until pregnancy

Question 8

PET - Symptom:

Usually asymptomatic

• Main symptom due to high BP
• Visual symptoms - 2
• Why do they get epigastric/RUQ pain?
• What would high BP force out of the blood?
• What could be an early symptom that indicates you are going to develop PET?

Answer 8

Headaches

Flashing lights or scotoma

The liver has been affected

Fluid leading to oedema in face, fingers and lower limbs

N&V

Question 9

PET - Signs:

• Neurological sign? - 3
• Resp sign?
• What could happen to the placenta which would be an emergency?

Answer 9

Hyperreflexia - ankle clonus, knees, bicep
Confusion
Fits

SOB

Placental abruption

Question 10

PET:

Eclampsia - how would this present?

Answer 10

Generalised tonic-clonic seizure (ante/postnatal)

Question 11

PET:

Risk factors:

PRECLAMP mneumonic

Answer 11

PRimp or Partner Replacement (pregnancy with a new partner)

Excess weight

Chronic diseases - HTN, DM, CKD

Little <20 yrs

Aged > 35 yrs

Multiple pregnancies

Past history or FH of PET

Question 12

PET:

Investigations:

• What is done for all pregnant women to screen for it?
• How is proteinuria diagnosed? - 2

PIGF:

• What does it stand for?
• Does PET cause it to be increased or decreased?

Tests for maternal organ dysfunction:

Answer 12

BP checks and urinalysis

Protein:creatinine ratio (PCR)
Albumin:creatinine ratio (ACR)

Placental growth factor

Decreased
---
Low platelets - thrombocytopenia 
LFTs - liver pathology
Creatinine  - AKI

Question 13

PET:

Prevention:
- What should be prescribed from 12 wks if high risk?

Answer 13

Aspirin

Question 14

PET - Management:

BP management:

• Over what BP are antihypertensives needed?
• What BP are you aiming for?
• What BP is classed as severe and needs admitting?

Antihypertensives used during pregnancy:

• 1st line - L
• 2nd line - N, H, M

Answer 14

> 140/90

<135/85

> ## 160/110 - check every 15 minutes then 4 times a dayLevodopa

Nifedipine
Hydralazine
Methyldopa

Question 15

PET:

Antenatal monitoring and care:

• List a few signs that could warrant admission?
• What is used as prophylaxis for severe PE or a full eclamptic fit?

Answer 15

Organ dysfunction detected from tests
BP 160>110
Pulmonary oedema
Fetal distress

Magnesium sulfate

Question 16

PET:

Delivery:

• What gestation should delivery be planned?
• If PET severe and delivery is done earlier than above, what should be given before delivery to help the baby?

Postpartum care:

• Gest HTN - how often is BP checked?
• PET - how often is BP checked if inpatient? what if the patient is discharged?
• How long after delivery should BP monitoring be done?

Answer 16

37 wks

BP daily for the first 2 days
Then once at 3-5 days

4 times a day

Every 2 days for 2 wks

6 wks

Question 17

PET - Complications:

Eclampsia:

• What is it?
• How does death occur? - 3
• Drug used? Dose? Route? How often?
• What if the seizures continue? What needs to be ruled out if it continues?
• What can be given if the first drug of choice reaches toxic levels?
• Fetal monitoring?

Answer 17

GTCS + PET

Cerebral haemorrhage
HELLP syndrome
Organ failure

Magnesium sulfate - 4g/IV - every 10 minutes

Diazepam + intracranial haemorrhage needs to be ruled out

Calcium gluconate

CTG

Question 18

PET - Complications:

Maternal:

• Brain
• What organs begin to fail?
• Vascular

Fetal - 3

Answer 18

Stroke

Heart, liver or kidney failure (tubular necrosis)

Microaneurysms, DIC
---
IUGR
Prematurity 
Abruption

Question 19

PET - Complications:

HELLP syndrome:

What does the mneumonic HELLP stand for?

Why do they get dark urine?

What GI symptoms would they get?

Rx

Answer 19

Haemolysis (dark urine)

Elevated
Liver enzymes

Low 
Platelet count 
---
Abdominal pain 
N&V

Induction of labour and delivery