WBR0969

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Obstetrics & Gynecology
Prompt	[[Prompt::A 27 year old G2P1 in her 14th week of gestation comes to the office for regular check-up. She has no specific complaints and takes her iron and folic acid supplements regularly. Her past history is significant for hypertension and on beta-blockers. She is a non-smoker and does not consume alcohol. Her family history is unremarkable. Her first child is alive, healthy and Rh –ve. On examination, her vitals are temperature: 36.7 C, blood pressure: 100/70 mmHg, pulse: 80/min and respirations: 15/min. All system examinations are normal. Which of the following would be the best next step in the management of this patient’s chronic hypertension ?]]
Answer A	AnswerA::Stop her beta-blockers
Answer A Explanation	AnswerAExp::''' Correct ''' : The patient can be withdrawn from previous medications as her BP is well within the control limits.
Answer B	AnswerB::Switch to methydopa
Answer B Explanation	[[AnswerBExp:: Incorrect  : Treat with appropriate antihypertensives (e.g.,methyldopa, labetalol, nifedipine) if a pregnant women has BP > 110/80 during pregnancy.]]
Answer C	AnswerC::Double the doze of the current regimen
Answer C Explanation	[[AnswerCExp:: Incorrect  : Systemic vascular resistance falls during pregnancy and hence the blood pressure. There is no need to double the doze of anti-hypertensives during pregnancy in this patient to control blood pressure.]]
Answer D	AnswerD::Add nifedipine
Answer D Explanation	[[AnswerDExp:: Incorrect  : Systemic vascular resistance falls during pregnancy and hence the blood pressure. There is no need to add an anti-hypertensive such as nifedipine during pregnancy in this patient to control blood pressure.]]
Answer E	AnswerE::Switch to hydralazine
Answer E Explanation	[[AnswerEExp:: Incorrect  : Labetolol can be safely administered during pregnancy to control hypertension.]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::Gestational hypertension (formerly known as pregnancy-induced hypertension)is idiopathic hypertension without significant proteinuria (< 300 mg/L) that develops at > 20 weeks’ gestation. As many as 25% of patients may go on to develop preeclampsia. Chronic hypertension refers to hypertension before conception and at < 20 weeks’gestation, or may persist for > 12 weeks postpartum. Up to one-third of patients may develop superimposed preeclampsia. Monitor BP closely and if the BP is less than 110/80 during pregnancy the patient can be withdrawn from previous medications, because systemic vascular resistance falls with the course of pregnancy and hence the blood pressure. Treat with appropriate antihypertensives (e.g.,methyldopa, labetalol, nifedipine) if a pregnant women has BP > 110/80 during pregnancy. Do not give ACEIs or diuretics, as ACEIs are known to lead to uterine ischemia, and diuretics can aggravate low plasma volume to the point of uterine ischemia. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Gestational hypertension, WBRKeyword::Pregnancy
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::