Pregnancy Hypertension Disorders Quiz

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Questions and Answers

What is the primary characteristic that differentiates pre-eclampsia from gestational hypertension?

  • Blood pressure readings
  • Presence of end-organ damage (correct)
  • Presence of proteinuria (correct)
  • Timing of hypertension diagnosis

Which blood pressure reading is diagnostic for severe pre-eclampsia?

  • ≥140/90 but ≤160/110 mmHg
  • ≥180/120 mmHg
  • ≥160/110 mmHg (correct)
  • ≤140/90 mmHg

What is the minimum criterion using the dipstick method for detecting proteinuria?

  • ≥2+ (correct)
  • ≥3+
  • ≥1+
  • ≥4+

Which condition is characterized by hypertension that normalizes after delivery within 12 weeks?

<p>PIH (D)</p> Signup and view all the answers

Which of the following is NOT indicative of end-organ damage?

<p>Liver enzymes raised to their normal value (A)</p> Signup and view all the answers

What must be present to classify a case as eclampsia?

<p>Presence of seizures (A), End-organ damage (C)</p> Signup and view all the answers

In the context of chronic hypertension with superimposed pre-eclampsia, which symptom indicates new onset end-organ damage?

<p>Uncontrolled blood pressure (C)</p> Signup and view all the answers

What severe condition results from severe pre-eclampsia with generalized tonic-clonic seizures (GTCS)?

<p>Eclampsia (C)</p> Signup and view all the answers

How is gestational hypertension uniquely defined compared to other hypertensive disorders in pregnancy?

<p>Elevated blood pressure without proteinuria (C)</p> Signup and view all the answers

Which of the following theories or issues is NOT related to pre-eclampsia and its complications?

<p>Chronic diabetes management (C)</p> Signup and view all the answers

Which condition is considered when assessing the severity of Pregnancy Induced Hypertension (PIH)?

<p>Severe PE (B), Eclampsia (C)</p> Signup and view all the answers

What is a potential complication of HELLP syndrome?

<p>Fetal distress (C)</p> Signup and view all the answers

What indicates the need for immediate termination of pregnancy in managing PIH?

<p>Gestational age ≤ 37 weeks (A)</p> Signup and view all the answers

Which Doppler finding is concerning in the assessment of fetal well-being in PIH?

<p>Absent end diastolic flow (C)</p> Signup and view all the answers

When is a Cesarean section (LSCS) indicated in PIH management?

<p>Poor Bishop score (C)</p> Signup and view all the answers

Which preventive measure is supported by ACOG for reducing the risk of PIH/PE during pregnancy?

<p>Aspirin 50-150 mg/day PO starting early in pregnancy (B)</p> Signup and view all the answers

Which of the following is NOT a proactive factor for developing PIH/PE?

<p>Obesity (A)</p> Signup and view all the answers

What is the primary purpose of predictive tests such as sFlt-1 and VEGF in relation to PIH?

<p>To predict the likelihood of developing high blood pressure (D)</p> Signup and view all the answers

Which of the following measures has been shown to have no proven benefit in preventing PIH/PE?

<p>Antioxidants (B), Low-salt diet (D)</p> Signup and view all the answers

In the context of severe pre-eclampsia, which of the following complications is directly associated?

<p>Increased risk of HELLP syndrome (B)</p> Signup and view all the answers

Which classification of pre-eclampsia requires termination of pregnancy at or above 34 weeks?

<p>Severe pre-eclampsia (B)</p> Signup and view all the answers

What is a common complication associated with severe pre-eclampsia that affects the liver?

<p>HELLP syndrome (D)</p> Signup and view all the answers

Which medication is administered to prevent seizures in cases of severe pre-eclampsia?

<p>Magnesium sulfate (C)</p> Signup and view all the answers

When might early delivery be indicated for a pregnant woman with severe pre-eclampsia?

<p>At or below 34 weeks (D)</p> Signup and view all the answers

Which delivery option is mentioned as potentially appropriate for managing severe pre-eclampsia?

<p>A combination of vaginal delivery and assisted methods (D)</p> Signup and view all the answers

Which combination of signs is most indicative of severe pre-eclampsia?

<p>Sudden onset headache + Visual disturbances + Epigastric pain (C)</p> Signup and view all the answers

What is the mechanism that leads to the visual disturbances observed in severe pre-eclampsia?

<p>Cerebral hypoxia resulting from impaired blood flow (C)</p> Signup and view all the answers

Which of the following laboratory findings would be consistent with severe pre-eclampsia?

<p>Urine output of 280 ml/24hr and proteinuria of 0.5 gr/24hr (C)</p> Signup and view all the answers

What is the primary therapy used to prevent eclampsia in patients with severe pre-eclampsia?

<p>Magnesium sulfate (A)</p> Signup and view all the answers

Which of the following is NOT typically associated with severe pre-eclampsia?

<p>Flushing and warmth of the extremities (D)</p> Signup and view all the answers

What is a key clinical characteristic of HELLP syndrome regarding blood pressure?

<p>Low diastolic pressure below 40 mmHg (C)</p> Signup and view all the answers

Which of the following is NOT a characteristic of Acute Fatty Liver of Pregnancy (AFP)?

<p>Decreased platelet count (B)</p> Signup and view all the answers

Which risk factor is associated with the likelihood of developing pregnancy-induced hypertension or pre-eclampsia?

<p>Being a second-time mother with a new paternity (A)</p> Signup and view all the answers

What should be closely monitored in patients affected by Acute Fatty Liver of Pregnancy due to a possibility of leading to encephalopathy?

<p>Ammonia levels (B)</p> Signup and view all the answers

Identifying features of disseminated intravascular coagulation (DIC) in Acute Fatty Liver of Pregnancy typically involves which of the following?

<p>Increased prothrombin time (A)</p> Signup and view all the answers

What is the drug of choice for treating hypertension in pregnancy?

<p>Labetalol (C)</p> Signup and view all the answers

Which of the following drugs is NOT safe to use during pregnancy for hypertension management?

<p>ACE Inhibitors (C)</p> Signup and view all the answers

Which blood pressure reading warrants the immediate use of IV anti-hypertensives?

<p>160/110 mm Hg (C)</p> Signup and view all the answers

Which laboratory finding is essential for the diagnosis of HELLP syndrome?

<p>LDH $ ext{ extgreater }$ 600 IU/L (A)</p> Signup and view all the answers

During a mild preeclampsia scenario, which is a key feature to monitor frequently?

<p>Blood pressure (D)</p> Signup and view all the answers

What type of cells might you observe in the peripheral blood smear of a patient with HELLP syndrome?

<p>Schistocytes and Helmet cells (D)</p> Signup and view all the answers

Which medication would be avoided in asthmatics for treating hypertension during pregnancy?

<p>Labetalol (C)</p> Signup and view all the answers

Which of the following statements is true regarding the recurrence rate of HELLP syndrome?

<p>Recurrence occurs in 85% of patients. (C)</p> Signup and view all the answers

Which condition is generally associated with an increased chance of HELLP syndrome?

<p>Multiparity (Multigravida) (B)</p> Signup and view all the answers

What is the typical threshold for anemia characterized by cuneiform or Bur cells in HELLP syndrome?

<p>Hemoglobin level is halved or less (A)</p> Signup and view all the answers

Which test is used to predict the risk of developing PIH in pregnant patients?

<p>Uterine Artery Doppler (D)</p> Signup and view all the answers

What is an indication for a Cesarean Section in PIH patients with an absent end diastolic flow?

<p>General anesthesia (C)</p> Signup and view all the answers

Which procedure should be performed to manage the second stage of labor in a patient with PIH?

<p>Cut short the second stage using instruments (A)</p> Signup and view all the answers

What is the correct action for a diagnosed PIH patient who shows reversed end diastolic flow during an examination?

<p>Termination of pregnancy with general anesthesia at 34 weeks (C)</p> Signup and view all the answers

Which of the following statements about post-delivery management in PIH is correct?

<p>Methylergometrine is administered after delivery regardless of delivery type. (C)</p> Signup and view all the answers

Flashcards

Hypertension in Pregnancy

Blood pressure ≥ 140/90 mmHg at two occasions, 4 hours apart.

Chronic Hypertension in Pregnancy

Persistent hypertension after delivery; remains high post-pregnancy.

Pre-eclampsia

Hypertension with proteinuria; BP ≥ 140/90 and possible organ damage.

Eclampsia

Severe form of pre-eclampsia; BP ≥ 160/110 with organ damage.

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Gestational Hypertension

High blood pressure during pregnancy without proteinuria or organ damage.

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Proteinuria

Presence of excess protein in urine; measured by dipstick or 24-hour collection.

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End-organ damage indicators

Signs of damage include low platelet count, high serum creatinine, liver enzyme elevation, CNS symptoms, or pulmonary edema.

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Chronic hypertension with pre-eclampsia

Hypertension in a pregnant woman leads to uncontrolled BP and organ damage.

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Impending Eclampsia

A warning stage before eclampsia, indicating escalating pre-eclampsia symptoms.

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HELLP Syndrome

A severe complication of pre-eclampsia characterized by hemolysis, elevated liver enzymes, and low platelets.

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Symptoms of Severe Pre-Eclampsia

Includes epigastric pain, nausea, jaundice, headaches, and visual disturbances due to liver or cerebral issues.

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Visual Disturbances in Pre-Eclampsia

New-onset reversible issues such as blurred vision, scotomas, and diplopia indicating high blood pressure effects.

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Disturbed Sleep as a Sign

Sudden onset of sleep disturbances can indicate worsening pre-eclampsia.

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MgSO4 Therapy

Magnesium sulfate used to prevent progression to eclampsia during severe pre-eclampsia management.

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Blood Pressure and Urine Output Criteria

In severe pre-eclampsia: BP ≥ 0.3 gr/24hr protein and urine output ≥ 300 ml/24hr.

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Hemolysis in HELLP

Destruction of red blood cells resulting in anemia, identified by schistocytes on a blood smear.

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Elevated Liver Enzymes

AST & ALT levels greater than or equal to 70 IU/L indicate liver dysfunction in HELLP.

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Low Platelet Count

Platelet count of 100,000 (1 lakh) or less is a key indicator in HELLP syndrome.

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Tennessee Criteria for HELLP

Diagnosis of HELLP requires LDH levels of 600 IU/L or greater among other criteria.

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Criteria for HELLP Syndrome

Presence of low blood pressure, proteinuria, and low platelet count without coagulation issues.

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Acute Fatty Liver of Pregnancy (AFP)

Characterized by hypoglycemia, hepatoreanal syndrome, and high ammonia leading to encephalopathy.

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Platelet Count in HELLP

Platelet count is low, usually without significant coagulation profile changes.

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Risk Factor: Previous Pre-eclampsia

A history of pre-eclampsia increases risk of future hypertensive disorders.

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Diabetes as a Risk Factor

Diabetes in pregnancy can cause placental enlargement and other complications.

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Complications of HELLP Syndrome

Includes fetal distress, kidney failure, and abruptio placentae.

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Umbilical Artery Doppler Indicators

Reduced or absent end diastolic flow in the umbilical artery.

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Termination Criteria for PIH

Pregnancy may be terminated at ≤ 37 weeks, ≥ 34 weeks, or immediately regardless of gestation.

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Mode of Delivery Indications

TOPER or LSCS (cesarean section) based on poor Bishop score or REDF.

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Conditions under PIH

Includes Mild PE, Severe PE, Impending Eclampsia, and Eclampsia.

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Mild Pre-eclampsia

Top at 37 weeks; usually less severe form of pre-eclampsia.

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Severe Pre-eclampsia

Top at ≥ 34 weeks; can cause fetal distress and organ issues.

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Management of Severe Pre-eclampsia

Includes early delivery and medications like magnesium sulfate.

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Signs of HELLP Syndrome

Includes hemolysis, elevated liver enzymes, and low platelets in severe cases.

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Delivery Methods for Severe Pre-eclampsia

Options include vaginal delivery, Cesarean, and assisted techniques like forceps.

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Uterine Artery Doppler

Test used to predict the risk of PIH.

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Umbilical Artery Doppler

Predicts prognosis in diagnosed PIH with AEDF and REDF.

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Absent End Diastolic Flow (AEDF)

Indicates poor blood flow in umbilical Doppler, suggests severe risk.

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Vaginal Delivery in PIH

Preferred delivery method in cases of Pregnancy Induced Hypertension.

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Indications for LSCS in PIH

Reasons to perform a Cesarean section in PIH cases include AEDF and poor Bishop score.

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Indications for Anti-hypertensive

Blood pressure readings indicate when to use anti-hypertensives: persistently high at 160/100 mm Hg or a single reading of 160/110 mm Hg.

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First-line Drugs during Pregnancy

Labetalol is the drug of choice for managing hypertension in pregnancy; avoid in asthmatics.

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Chronic Hypertension Treatment

First-line oral medications for chronic hypertension in pregnancy include labetalol, nifedipine, and methyldopa.

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Mild Preeclampsia Monitoring

Mild preeclampsia requires frequent BP monitoring and lab tests; usually admitted for PIH.

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Hydralazine Usage

Hydralazine is generally not used for chronic hypertension management in pregnancy.

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Aspirin for PIH/PE

Aspirin 50-150 mg/day is recommended to prevent preeclampsia.

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Unproven Preventative Measures

Bedrest, salt-restricted diet, and antioxidants do not prove beneficial in pregnancy.

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Predictive Tests for BP

Tests like serum endothelin and sFlt-1 predict the risk of PIH.

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Proactive Factor for PIH

Smoking is a known proactive risk for developing PIH or PE.

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Calcium Supplements in Pregnancy

Calcium supplementation is advised only if levels are low during pregnancy.

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