Urine examination is mandatory.

True

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Anti-hypertensive treatment should be started.

True

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False

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True

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There are three types of hypertensive disorders in pregnancy: chronic hypertension, gestational hypertension and pre-eclampsia. Hypertension in pregnancy may be defined as an absolute increase in blood pressure >140/90 mmHg or a relative rise in blood pressure in either systolic pressure >30 mmHg or diastolic pressure >15 mmHg above blood pressure at pre-natal booking.

Chronic hypertension should be diagnosed in a patient who has a known history of hypertension before pregnancy or if the hypertension occurred before 20 weeks' gestation.

Gestational hypertension occurs in the second half of pregnancy and resolves by 6 weeks post partum.

Pre-eclampsia is defined as gestational hypertension with >0.3 g proteinuria per 24 hours. Oedema is not essential as it is a non-specific finding.

Most physicians would start treatment if blood pressure is >140/90 mmHg. In general, apart from angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB), most conventional anti-hyper- tensive drugs are not fetotoxic or contraindicated in pregnancy. The first-line drug of choice remains to be methyldopa, which is a centrally acting agent with a long safety record in pregnancy. Its sedative side effect sometimes limits its application and it may cause increases in liver enzymes or a positive Coomb's test. It should be avoided in women with a prior history of depression and after delivery, preferably it should be changed to other drugs if possible to decrease the risk of post-partum depression.

Second-line drugs include nifedipine and hydralazine and third-line drugs include beta blockers and thiazide diuretics. Beta blockers have concerns of growth restriction and thiazides might cause plasma volume contraction, thereby limiting their use to third line in general. After delivery, however, a beta blocker is often the drug of first choice for blood pressure control.

What is the machine called?

It is a phototherapy unit. The lamps of this machine deliver ultraviolet B in the range of 310 to 315 nm and so it is a narrow-band UVB irradiation unit.

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What is the commonest skin disorder that will benefit from this specific form of therapy?

Psoriasis

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Under what other skin disorders may one utilize this form of therapy?

Other dermatoses that respond to narrow-band UVB include atopic eczema, vitiligo, lichen planus, polymorphic light eruption and some other idiopathic photodermatoses, pityriasis rosea and mycosis fungoides (early stages).

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What other forms of therapy with a similar underlying principle do you know of?

These include PUVA (oral psoralen + UVA (320-400 nm)), bath PUVA, topical PUVA, UVA1 (340-400 nm) phototherapy, broad band UVB (290-320 nm), excimer laser therapy and photodynamic therapy.

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What are the possible side effects of this form of therapy?

Possible acute side effects include sunburn reaction, corneal burn (if eyes unprotected), freckling and tanning of skin, phototoxic or photoallergic drug eruptions. In the long run, premature ageing of skin and possible increased risk of skin cancers should be considered.

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