Review Practice Exercise 1

Hypertensive Disorders > Maternal Newborn

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Practice Exercise 1

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Total Questions : 5

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Question 1:

Which of the following defines gestational hypertension?

A. Blood pressure ≥140/90 mmHg before 20 weeks of gestation B. Blood pressure ≥140/90 mmHg after 20 weeks with proteinuria C. Blood pressure ≥140/90 mmHg after 20 weeks without proteinuria D. Blood pressure ≥160/110 mmHg with seizures

Answer and Explanation

Choice A:

Blood pressure ≥140/90 mmHg before 20 weeks indicates chronic hypertension, not gestational hypertension. Hypertension diagnosed before 20 weeks is presumed to be pre-existing and is not pregnancy-induced. The timing here excludes gestational hypertension.

Choice B:

Blood pressure ≥140/90 mmHg after 20 weeks with proteinuria defines preeclampsia, not gestational hypertension. The presence of proteinuria (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3) indicates renal involvement and systemic disease, which is a hallmark of preeclampsia.

Choice C:

Blood pressure ≥140/90 mmHg after 20 weeks without proteinuria defines gestational hypertension. The absence of proteinuria or systemic signs differentiates it from preeclampsia. The timing after 20 weeks is critical for diagnosis, and the threshold values match the accepted criteria.

Choice D:

Blood pressure ≥160/110 mmHg with seizures defines eclampsia, a severe complication of preeclampsia. Seizures in a hypertensive pregnant woman indicate neurological involvement and progression beyond gestational hypertension. This is a medical emergency requiring immediate intervention.

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Question 2:

What is a key clinical manifestation of preeclampsia without severe features?

A. Platelet count <100,000/μL B. Proteinuria ≥300 mg in 24 hours C. Blood pressure ≥160/110 mmHg D. Pulmonary edema

Answer and Explanation

Choice A:

Platelet count <100,000/μL indicates thrombocytopenia, a severe feature of preeclampsia. It reflects platelet consumption due to endothelial activation and microvascular injury. This finding upgrades the diagnosis to preeclampsia with severe features.

Choice B:

Proteinuria ≥300 mg in 24 hours is a defining feature of preeclampsia without severe features. It reflects glomerular endothelial injury and increased permeability. The absence of other systemic signs confirms the classification as “without severe features.”

Choice C:

Blood pressure ≥160/110 mmHg meets the threshold for severe hypertension, which is a severe feature of preeclampsia. It increases risk for stroke and other complications, requiring urgent antihypertensive therapy and closer monitoring.

Choice D:

Pulmonary edema is a life-threatening complication and a severe feature of preeclampsia. It results from capillary leak and reduced oncotic pressure, often requiring intensive care and delivery planning. Its presence excludes the “without severe features” classification.

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Question 3:

A 28-year-old primigravida at 34 weeks gestation presents with new-onset blood pressure readings of 150/98 mmHg and 148/96 mmHg four hours apart, along with 2+ proteinuria on a dipstick. She denies headache or visual changes. Which of the following is the most likely diagnosis?

A. Gestational hypertension B. Chronic hypertension C. Preeclampsia without severe features D. Preeclampsia with severe features

Answer and Explanation

Choice A:

Gestational hypertension is defined as new-onset hypertension after 20 weeks without proteinuria or systemic signs. This patient has 2+ proteinuria, which excludes gestational hypertension and supports a diagnosis of preeclampsia.

Choice B:

Chronic hypertension is diagnosed when elevated blood pressure is present before 20 weeks gestation or persists beyond 12 weeks postpartum. This patient is 34 weeks gestation with new-onset hypertension, making chronic hypertension unlikely.

Choice C:

The patient has blood pressure readings ≥140/90 mmHg on two occasions 4 hours apart and 2+ proteinuria on dipstick, meeting the criteria for preeclampsia without severe features. The absence of neurologic symptoms or other systemic signs confirms the lack of severe features.

Choice D:

Preeclampsia with severe features requires signs of end-organ dysfunction, such as severe hypertension (≥160/110 mmHg), thrombocytopenia, elevated liver enzymes, renal insufficiency, pulmonary edema, or CNS symptoms. This patient lacks all severe features, making this diagnosis incorrect.

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Question 4:

Which of the following are risk factors for developing preeclampsia? Select all that apply

A. Nulliparity B. Chronic hypertension C. Gestational age <20 weeks D. Obesity E. Previous cesarean delivery

Answer and Explanation

Choice A:

Nulliparity is a well-established risk factor due to lack of prior maternal immune adaptation to fetal antigens. Immune maladaptation and vascular remodeling defects are more common in first pregnancies, increasing susceptibility to preeclampsia.

Choice B:

Chronic hypertension predisposes to preeclampsia due to pre-existing vascular damage and endothelial dysfunction. These changes amplify the placental ischemia and systemic inflammation seen in preeclampsia.

Choice C:

Gestational age <20 weeks is not a risk factor but rather excludes the diagnosis of preeclampsia. The condition cannot occur before 20 weeks because placental development and vascular remodeling are incomplete. Hypertension before 20 weeks suggests chronic hypertension or other etiologies.

Choice D:

Obesity increases risk through chronic inflammation and insulin resistance, which contribute to endothelial dysfunction. Adipose tissue also alters cytokine profiles and promotes hypertension, enhancing susceptibility.

Choice E:

Previous cesarean delivery is not a recognized independent risk factor for preeclampsia. While it may be associated with placental abnormalities in future pregnancies, such as accreta or previa, it does not directly increase the risk of endothelial dysfunction or abnormal placentation.

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Question 5:

Which of the following are recognized risk factors for developing preeclampsia? Select all that apply

A. Primigravidity B. History of gestational hypertension in a prior pregnancy C. Chronic hypertension D. Multifetal gestation E. Maternal age under 20 years

Answer and Explanation

Choice A:

Primigravidity is a major risk factor due to lack of prior maternal immune adaptation to fetal antigens. Immune maladaptation and defective spiral artery remodeling increase susceptibility to placental ischemia and systemic inflammation.

Choice B:

History of gestational hypertension in a prior pregnancy increases recurrence risk due to persistent vascular sensitivity and placental dysfunction. Prior endothelial injury may predispose to future hypertensive disorders.

Choice C:

Chronic hypertension contributes through pre-existing vascular damage and impaired endothelial regulation, which amplify the pathophysiologic mechanisms of preeclampsia.

Choice D:

Multifetal gestation increases placental mass and angiogenic demand, heightening the risk of placental hypoperfusion and systemic endothelial activation.

Choice E:

Maternal age under 20 years is not a recognized independent risk factor. While younger age may be associated with socioeconomic disparities or limited prenatal care, it does not directly contribute to the pathophysiology of preeclampsia. Advanced maternal age (>35 years) is a more established risk factor due to vascular aging and comorbidities.

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Practice Exercise 1

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