[1] Hypertension in Pregnancy and Gestational Diabetes Mellitus Flashcards
Leading cause of maternal and fetal morbidity
HPN in Pregnancy
Most benign in spectrum of hypertensive disorders in pregnancy
Gestational Hypertension
Define: Gestational HPN
BP> 140/90 mmHg after 20 weeks in previously normotensive women
Is there proteinuria in Gestational HPN?
No
Criteria for Pre-eclampsia
with regards to Proteinuria
HPN + Proteinuria >= 300mg/24 hours
OR
Protein:Creatinine Ratio >= 0.3
OR
Dipstick 1 + Persistent
Criteria for Pre-eclampsia
alternate criteria without Proteinuria
HPN +
Thrombocytopenia: Platelets < 100,00/uL
Renal Insufficiency: Creatinine > 1.1mg/dL or double baseline
Liver Involvement: Serum Transaminase 2x normal
Cerebral Symptoms: Headache, visual disturbances, convulsions
Pulmonary Edema
Criteria for Proteinuria in Pre-Eclampsia
- Urinary protein spillage of 300mg or more in 24 hours
- Urinary protein concentration of 100mg/dL
- More in 2 random specimens taken 6 hours apart
[Exam Tip Card]
This is a marker for diagnosis of severe pre-eclampsia in HPN pregnant women
Growth restricted fetus
[Exam Tip Card]
Cases will be given and we are supposed to define the different terminologies in HPN
Go memorize them!
Define: Eclampsia
Presence of convulsions in a woman with pre-eclampsia, in which the convulsions cannot be attributed to any other cause
[Non-severe vs. Severe Pre-eclampsia]
Diastolic BP
N: 110 mmHg
[Non-severe vs. Severe Pre-eclampsia]
Diastolic BP
N: 160 mmHG
Indicators present in severe pre-eclampsia but absent in non-severe cases
- Headache
- Visual Disturbances
- Upper Abdominal Pain
- Oliguria
- Eclampsia
- Thrombocytopenia
- Fetal Growth Restriction
- Pulmonary Edema
A fetus is a prerequisite for pre-eclampsia
It is not, pregnancy does not require a fetus, it could be a hydatidiform mole
Describe the Endothelial dysfunction in the Pathogenesis of Pre-eclampsia
Normal Pregnancy: Prostaglandin to Thromboxane ratio is high, but in HPN the Thromboxane levels are increased while Prostaglandins are decreased
Modality used to check uteroplacental flow
Doppler Ultrasound
One can use Doppler UTZ to check uteroplacental flow as early as how many weeks AOG
16-22 Weeks
Persistence of uterine artery notching beyond how many weeks is predictive of hypertensive complications during pregnancy?
22-24 Weeks
Drug of Choice as Anticonvulsant
Magnesium Sulfate
Surefire Cure for Pre-Eclampsia
Delivery
Glycemic Control Pre-Prandial Glucose Aim
≤95mg/dL
Glycemic Control 1 Hour Post-Prnadial Glucose Aim
≤140mg/dL
Glycemic Control 2 Hour Post-Prnadial Glucose Aim
≤120 mg/dL
