Hypertension in Pregnancy Quiz
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Hypertension in Pregnancy Quiz

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Questions and Answers

What makes pregnancies complicated by chronic hypertension categorized as high risk?

Chronic hypertension is associated with increased maternal and fetal morbidity.

What percentage of women with gestational hypertension may progress to pre-eclampsia?

Up to one-third of women.

At what blood pressure readings is hypertension classified as mild?

Mild hypertension is classified as a diastolic blood pressure of 90-99 mmHg and a systolic blood pressure of 140-149 mmHg.

What are the three classifications of hypertension in pregnancy mentioned?

<p>Non-proteinuric pregnancy-induced hypertension, pre-eclampsia, and chronic hypertension.</p> Signup and view all the answers

Define pre-eclampsia and its key diagnostic criteria.

<p>Pre-eclampsia is defined as new-onset hypertension of at least 140/90 mmHg and at least 300 mg protein in urine after the 20th week of pregnancy.</p> Signup and view all the answers

Why is chronic hypertension considered a significant factor in pregnancy?

<p>It is associated with increased risks of developing pre-eclampsia and fetal growth restriction (FGR).</p> Signup and view all the answers

What are the criteria for diagnosing pre-eclampsia in a previously normotensive woman?

<p>Diagnosis requires hypertension recorded on at least two occasions and at least 300 mg of protein in a 24-hour urine collection.</p> Signup and view all the answers

What is the primary difference between gestational hypertension and pre-eclampsia?

<p>Gestational hypertension occurs without proteinuria, while pre-eclampsia is diagnosed with the presence of proteinuria.</p> Signup and view all the answers

List two risk factors for pre-eclampsia in pregnant women.

<p>First pregnancy and age 40 years or more are two risk factors for pre-eclampsia.</p> Signup and view all the answers

What is the estimated global annual maternal death rate due to pre-eclampsia according to WHO?

<p>Between 50,000 and 75,000 women.</p> Signup and view all the answers

What is the threshold for diastolic blood pressure indicating moderate hypertension?

<p>Moderate hypertension is defined as a diastolic blood pressure of 100-109 mmHg.</p> Signup and view all the answers

What are the potential long-term risks associated with pre-eclampsia for both mother and baby?

<p>Increased risks of chronic hypertension for mothers and fetal growth restriction for babies.</p> Signup and view all the answers

What are some clinical presentations of pre-eclampsia?

<p>Clinical presentations can include hypertension, proteinuria, elevated liver enzymes, and CNS symptoms.</p> Signup and view all the answers

What condition is described as hypertension arising for the first time in the second half of pregnancy without proteinuria?

<p>Non-proteinuric pregnancy-induced hypertension, also known as gestational hypertension.</p> Signup and view all the answers

Explain why chronic hypertension can mask underlying hypertensive tendencies during early pregnancy.

<p>The physiological fall in blood pressure due to peripheral vasodilatation can obscure chronic hypertension indicators.</p> Signup and view all the answers

What management approach is generally taken for mild to moderate increases in blood pressure with gestational hypertension?

<p>They typically do not require treatment.</p> Signup and view all the answers

What are the three key components of HELLP syndrome?

<p>Haemolysis, elevation of liver enzymes, and low platelet count.</p> Signup and view all the answers

How does the presence of hypertension relate to cerebral pathology in pre-eclampsia?

<p>Hypertension alone is not responsible for cerebral pathology; vasospasm and cerebral oedema also play significant roles.</p> Signup and view all the answers

What are the common symptoms presented by women with pre-eclampsia?

<p>Common symptoms include frontal headache, visual disturbance, and epigastric pain.</p> Signup and view all the answers

What cardiovascular changes are typically associated with pre-eclampsia?

<p>Generalized vasospasm, increased peripheral resistance, and reduced central venous/pulmonary wedge pressures.</p> Signup and view all the answers

In the context of renal function, what findings are indicative of pre-eclampsia?

<p>Proteinuria, decreased glomerular filtration rate, and decreased urate excretion.</p> Signup and view all the answers

What are some underlying medical conditions that may contribute to pre-eclampsia?

<p>Pre-existing hypertension, renal disease, diabetes, and antiphospholipid antibodies.</p> Signup and view all the answers

What is the significance of trophoblast invasion in the development of pre-eclampsia?

<p>Trophoblast invasion is critical for remodeling spiral arteries, and ineffective invasion can lead to uteroplacental ischaemia.</p> Signup and view all the answers

How does the cardiovascular system respond in normal pregnancy compared to pre-eclampsia?

<p>Normal pregnancy involves peripheral vasodilatation with reduced total peripheral resistance, while pre-eclampsia is marked by vasoconstriction and hypertension.</p> Signup and view all the answers

What is 'glomeruloindotheliosis' and its relevance to pre-eclampsia?

<p>'Glomeruloindotheliosis' is a characteristic kidney lesion associated with impaired glomerular filtration and proteinuria in pre-eclampsia.</p> Signup and view all the answers

What role does endothelial damage play in the haematological changes seen in pre-eclampsia?

<p>Endothelial damage leads to platelet adhesion and fibrin deposition, resulting in changes in platelet count.</p> Signup and view all the answers

What are the physiological changes to spiral arteries due to trophoblast invasion?

<p>The physiological changes include the remodeling of spiral arteries which decreases their muscular walls to allow for increased blood flow.</p> Signup and view all the answers

Describe the biophysiological response of the vascular system in pre-eclampsia.

<p>In pre-eclampsia, there is increased vascular permeability due to hypertension and endothelial cell damage, leading to edema.</p> Signup and view all the answers

Explain the connection between oxidative stress and the progression of pre-eclampsia.

<p>Uteroplacental ischaemia leads to oxidative stress which is involved in endothelial dysfunction and exacerbates hypertensive symptoms.</p> Signup and view all the answers

What is eclampsia and how does it differ from pre-eclampsia?

<p>Eclampsia is characterized by generalized convulsions and/or coma occurring in the context of pre-eclampsia. It differs from pre-eclampsia, which involves high blood pressure and protein in the urine without convulsions.</p> Signup and view all the answers

Identify two common symptoms that may indicate imminent eclampsia.

<p>Severe frontal headache and visual disturbances are two common symptoms that may indicate imminent eclampsia.</p> Signup and view all the answers

What is the primary cause of death associated with eclampsia?

<p>Cerebral haemorrhage is reported as the most common cause of death in patients with eclampsia.</p> Signup and view all the answers

What role does magnesium sulfate play in the management of patients with pre-eclampsia?

<p>Magnesium sulfate is administered to prevent seizures in women with severe pre-eclampsia or those considered unstable.</p> Signup and view all the answers

List two risk factors for developing eclampsia.

<p>Uncontrolled hypertension and a history of diabetes are two risk factors for developing eclampsia.</p> Signup and view all the answers

What is the aim of antihypertensive medication in patients with mild pre-eclampsia?

<p>The aim is to maintain blood pressure below 160 mmHg systolic and 80–100 mmHg diastolic.</p> Signup and view all the answers

What are the preferred antihypertensive agents for managing mild hypertension during pregnancy?

<p>Labetalol, nifedipine, and methyldopa are the preferred antihypertensive agents.</p> Signup and view all the answers

When is delivery usually offered to women requiring antihypertensive medication during pregnancy?

<p>Delivery is usually offered around 39 weeks of gestation.</p> Signup and view all the answers

Study Notes

Hypertension in Pregnancy

  • Prevalence: Approximately 1 in 10 women experience raised blood pressure during pregnancy.
  • Types:
    • Gestational Hypertension: Develops in the second half of pregnancy, without proteinuria. Not typically associated with adverse outcomes. Up to one-third can progress to preeclampsia.
    • Preeclampsia: Develops after the 20th week of pregnancy, characterized by hypertension and proteinuria. Can lead to maternal and fetal complications.
    • Chronic Hypertension: Pre-existing hypertension prior to pregnancy. Increased risk of preeclampsia and fetal complications.
  • Preeclampsia:
    • Prevalence: 2-3% of pregnancies globally.
    • Mortality: 70,000 women die annually from preeclampsia, a leading cause of maternal death in low-resource settings.
    • Definition: Hypertension of at least 140/90 mmHg on two separate occasions, 4 hours apart, with proteinuria (≥300 mg in 24-hour urine), arising in a previously normotensive woman after the 20th week of pregnancy, resolving by the sixth postpartum week.
    • Pathophysiology:
      • Two-stage process:
        • Stage 1: Inadequate trophoblast invasion of the spiral arteries, leading to uteroplacental ischemia.
        • Stage 2: Uteroplacental ischemia triggers oxidative and inflammatory stress, resulting in endothelial dysfunction, vasospasm, and coagulation activation.
    • Organ involvement:
      • Cardiovascular: Vasoconstriction leading to hypertension, increased vascular permeability and fluid shifts.
      • Renal: Glomeruloindotheliosis, impaired glomerular filtration, proteinuria, and edema.
      • Haematological: Platelet adhesion and aggregation, fibrin deposition leading to thrombocytopenia and disseminated intravascular coagulation (DIC).
      • Hepatic: Subendothelial fibrin deposition causing elevated liver enzymes, HELLP syndrome (haemolysis, elevated liver enzymes, low platelets).
      • Neurological: Vasospasm, cerebral edema leading to seizures (eclampsia), retinal haemorrhages, exudates, and papilloedema.
    • Symptoms:
      • Classic symptoms: frontal headache, visual disturbances, epigastric pain.
      • Majority are asymptomatic or have vague flu-like symptoms.
    • Risk Factors:
      • First pregnancy
      • Multiparous with previous history of preeclampsia
      • Age 40 years or more
      • BMI of 35 or more
      • Family history of preeclampsia
      • Booking diastolic blood pressure of 80 mmHg or more
      • Booking proteinuria
      • Multiple pregnancy
      • Pre-existing hypertension, renal disease, diabetes, antiphospholipid antibodies.
  • Eclampsia: Generalized convulsions or coma occurring in a woman with preeclampsia in the absence of other neurological conditions. Occurs in 1/2000 deliveries, complicating 1-2% of preeclampsia cases.
    • Risk Factors: Uncontrolled hypertension, inadequate prenatal care, primigravidity, obesity, Black ethnicity, history of diabetes, age 40 years or more, multiple pregnancy, connective tissue disease, antiphospholipid syndrome.
  • Management:
    • Preeclampsia:
      • Mild: Blood pressure below 160 mmHg systolic and 80–100 mmHg diastolic.
      • Severe: Blood pressure above 160 mmHg systolic and 110 mmHg diastolic.
      • Antihypertensive Medication: Labetolol, nifedipine, methyldopa.
      • Delivery: Typically offered around 39 weeks for pre-existing hypertension, earlier if complications arise.
    • Preeclampsia with eclampsia: Magnesium sulfate administration.
  • Long-term Risks:
    • Increased risk of cardiovascular disease and stroke in women with preeclampsia or chronic hypertension.
    • Premature birth, low birth weight, and stillbirth in babies born to mothers with preeclampsia.

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Description

Test your knowledge on hypertension during pregnancy. This quiz covers the prevalence, types such as gestational hypertension and preeclampsia, and their implications for maternal and fetal health. Understand the risks and definitions related to this critical aspect of prenatal care.

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