high bp

Question 1

if high bp < 20w

Answer 1

preexisting or molar pregnancy

Question 2

if high bp > 20w -ve proteinuria

Answer 2

gestational htn

Question 3

if high bp > 20w +ve proteinuria

Answer 3

pre eclampsia

Question 4

what are the high risk factors for pre eclampsia

Answer 4

chronic htn, ckd, apl/sle, t1/t2 dM, pHx pre- eclampsia

Question 5

what are the moderate risk factors for pre eclampsia

Answer 5

1st preg, 40+ y, >35 bmi at booking , multiple preg, fhx preeclampsia

Question 6

when are women offered prophylaxis for pre eclampsia? what is it?

Answer 6

if they have 1 high rf or 2 moderate rf
start on 75- 150mg aspirin daily ( low dose) from 12w to birth

Question 7

what is needed for a diagnosis be made of pre eclampsia

Answer 7

Systolic blood pressure above 140 mmHg
Diastolic blood pressure above 90 mmHg

PLUS any of:

• Proteinuria (1+ or more on urine dipstick)
• Organ dysfunction (e.g. raised creatinine, elevated liver enzymes, seizures, thrombocytopenia or haemolytic anaemia)
• Placental dysfunction (e.g. fetal growth restriction or abnormal Doppler studies)

Question 8

what are the symptoms of pre eclampsia

Answer 8

mild- asymptomatic
severe -
Headache
Visual disturbance or blurriness
Nausea and vomiting
Upper abdominal or epigastric pain (this is due to liver swelling)
Oedema
Reduced urine output
Brisk reflexes

Question 9

what should midwife do if measured high bp

Answer 9

urgent 2’ referral if pre eclampsia is suspected

Question 10

how is pre eclampsia treated

Answer 10

• labetalol or nifedipine ( if asthmatic)
• if pre existing- stop other antihypertensitive
• if stable delivery 37 w if severe- before
• give corticosteroids to develop baby lungs

Question 11

what are the complications of high bp

Answer 11

• eclampsia + seizures
• HELLP (haemolysis, elevated LFTs, low platelets)
• DIC, IUGR ( Intrauterine growth restriction)
• Placental abruption

Question 12

What are the symptoms of HELLP

Answer 12

increased deep tendon reflexes, RUQ pain, N+V

Question 13

if overdose with mgso4 what do you give

Answer 13

calcium gluconate

Question 14

why do you need to monitor mgso4

Answer 14

for mg toxicity as it can cause- sweating, flushing, hypotension, low temp, dizzy, low HR, headaches

Question 15

when monitoring mg for mgso4 toxiciy what do you measure

Answer 15

bp, rr, dtr ( deep tendon reflexes)

Question 16

what do you give to prevent sizures with pre eclampsia?

Answer 16

give mgso4 for fetal neuroprotections- iv 4g loading then 1g/hour
during labour and 24hr after

Question 17

what do you do for HELLP

Answer 17

deliver baby asap
after 34 w as per NICE guidelines