1. Hypertensive Disorders of Pregnancy A self learning package for midwives.

2. How to use this package  This package is designed to help you develop your decision making skills.  There are 3 case studies to work through. Each case study will question your knowledge.  Click on the correct answer and you will advance to the next question. You will be given an opportunity to try again if incorrect.

3. Instructions  Click on one of the tabs below to begin.  Good luck.  Outside links are available in this presentation. Case 2Case 1Case 3Case 1

4.  A woman presents to a midwife clinic at 36wks gestation with a blood pressure of 140/100. Her blood pressure at booking had been 100/60.  There is no oedema or proteinuria. Your management would be? Advise her to rest and see in 1 week? Organise an induction of labour? Perform a PIH assessment? Make an appointment for the high risk clinic? Case 1Case 2 Case Case 3

5. Case 1 cont’d  The blood pressure remains elevated, the blood results are normal. What would be your management? Admit to the ward for hypertensive medication? Arrange an induction of labour? Arrange an appointment for 1 week? Advise her to rest? Case 3Case 2Case 1

6. Case 1 cont’d Her blood pressure stabilizes with the hypertensive medication. She is booked for an induction of labour at 40 wks gestation. Choose the appropriate indication for induction of labour. Pregnancy induced hypertension? Pre-eclampsia? IUGR? Eclampsia Case 2Case 3Case 1

7. Case 2 You receive a phone call at 10pm from a woman who says she feels unwell. Her face has become swollen and she feels some discomfort similar to indigestion. What would you do? Advise her to rest ? Tell her to present to the ward the following day? Reassure her that this is normal? Advise her to come in immediately for assessment? Case 1Case 2Case 3

8. Case 2 cont’d On arrival she has a blood pressure of 160/110. She also has proteinuria. She complains of a frontal headache and has brisk reflexes. What would be the appropriate management? Start a 24hr urine collection? Notify the registrar immediately of her arrival? Book her for induction of labour? Advise her to rest and organise a High Risk appointment? Case 1Case 2Case 3

9. Case 2 cont’d The registrar has ordered blood tests and they confirm an elevated uric acid and decreased platelets. There is also proteinuria. An induction of labour is commenced for what reason? Pre-eclampsia? Fatty Liver Syndrome? Pregnancy induced hypertension? Hypertension? Case 1Case 2Case 3

10. A young girl arrives on the ward. She is 30 weeks pregnant. Urine test shows ++++ protein. Blood pressure is 170/120. What would you do? Administer Valium IV stat and commence fetal monitoring? Call the registrar and prepare to administer Magnesium Sulphate? Prepare for an emergency Caesarean Section? Arrange an induction of labour? Case 1Case 2Case 3

11. Case 3 cont’d Blood pressure remains elevated with Magnesium Sulphate. Blood tests reveal an elevated uric acid and decreased platelets. Suddenly she begins to have a fit and a code blue is called. What is her diagnosis? Severe Pre-eclampsia? Pregnancy Induced Hypertension? Fatty Liver disease? Eclampsia Case 1Case 2Case 3

12. Try again Case 2Case 1Case 3 http://www.magpietrial.org.uk/

13. Right Answer. End Show Case 2Case 3

14. Try again Case 2Case 1 cont’dCase 3

15. Right Answer. You’ve completed the package. http://www.rwh.org.au/rwhcpg/maternity.cfm?doc_id=5110

16. References  http://www.aapec.org.au http://www.aapec.org.au  Felix the Cat www.everwonder.com/david/felixthecatwww.everwonder.com/david/felixthecat  Lloyd.C.(2003).Hypertensive disorders of pregnancy. In Myles. A Textbook for Midwives. (C Fraser. D.M.Cooper, M.A. eds.) 357-371. London:Churchill.  http://www.magpietrial.org.uk/ http://www.magpietrial.org.uk/  http://www.rwh.org.au/rwhcpg/maternity.cfm?doc_id=5110http://www.rwh.org.au/rwhcpg/maternity.cfm?doc_id=5110 End Show

17. Try again Case 2 con’tCase 3

18. Try again Case 2 con’tCase 3

19. Try again Case 3 con’t