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Endo/Repro II Test 1 > 12. HTN Disorders in Pregnanct > Flashcards

12. HTN Disorders in Pregnanct Flashcards

1
Q

What’s the difference between chronic vs. gestational HTN?

A
  • Chronic HTN is present before or recognized during first half of preg.

- Gestational HTN is recognized after 20 weeks gestation

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2
Q

BP Guidelines:

  • NL
  • Elevated
  • Stage 1
  • Stage 2
  • Hypertensive crisis
A
  • NL: 120/80
  • Elevated: 120-129/ less than 80
  • Stage 1: 130-139/ 80-89
  • Stage 2: at least 140/ at least 90
  • Hypertensive crisis: systolic over 180 and/or diastolic over 120
    • No other indications of problems = pt needs to change meds ASAP
    • Signs of organ damage = immediate hospitiliation
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3
Q

What is needed for the diagnosis of preeclampsia?

A
  1. HTN after 20 weeks gestation
  2. Proteinuria
  3. (Edema)
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4
Q

What is eclampsia?

A

Preclampsia + new onset of seizures

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5
Q

Superimposed preeclampsia/eclampsia

A

Transposed on chronic HTN

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6
Q

Chronic HTN

  • What is important to evaluate?
A
  1. Look for maternal end-organ damage:
    1. CBC/CMP
    2. Glucose
    3. 24 hour urine colletion (or spot urine protein:Cr ratio)
    4. EKG
    5. ECG
  2. Assess well-being of fetus
    1. Initial US
    2. Screening US
    3. Growth US monthly after 28 weeks
    4. Antepartum fetal testing between 32-42 weeks
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7
Q

Manage mild chronic HTN (BP less than 160/110) => 5

  • Deliver
A
  1. 12 weeks => delivery: 81mg of Aspirin daily
  2. Anti-HTN if threshold value is reached
  3. Prenatal visits every 2-4 weeks until 34-36 weeks, then weekly after.
  4. Antepartum fetal monitoring
  5. Deliver: 39-40 weeks.
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8
Q

Severe HTN (BP >160/110)

Treat HTN? (3)

A
  1. Methyldopa
  2. Labetalol
  3. Nifedipine
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9
Q

What should be AVOIDED in severe chronic HTN?

Why.

A
  1. ACE-I
  2. Angiotensin-receptor blockers
  • ↑ risk of malformations (renal dysgenesis, calvarial hypoplasia, fetal growth restriction)
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10
Q

Management of Severe Chronic HTN.

  • ​Monitor:
  • If renal disease,
  • Antepartum fetal surveillance (=> ____ )
  • Deliver:
A
  1. Monitor during PG for change in dose
  2. Monitor to see if superimposed preeclampsia develops
  3. If renal disease, 24 hour urine collection/trimester
  4. Antepartum fetal surveillance
    1. Growth US ever 3-4 weeks
    2. NST/biophysical profile test
  5. Deliver: 38 weeks after gestation.
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11
Q

What is gestational HTN?

A
  1. HTN after 20 weeks or within 48-72 hours after delivery and goes away by 12 weeks postpartum
  2. Without any features of preclampsia
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12
Q

What are 4 sx’s of preeclampsia?

A
  1. Scotoma (blind spot)
  2. Blurred vision
  3. HA
  4. Epigastric and/or RUQ pain
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13
Q

What may be seen in the brain, heart, and lungs of patient with preeclampsia?

A
  1. Brain = cerebral edema and/or fibrinoid necrosis, thrombosis, microinfarcts and petechial hemorrhages
  2. Heart = absence of NL intravascular volume expansion (third spacing) and ↓ in circulating blood volume
  3. Lungs = noncardiogenic pulmonary edema
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14
Q

What ages are more at risk for preeclampsia?

A

Less than 20 and older than 35.

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15
Q

Which level of proteinuria is associated with mild vs. severe preeclampsia?

A
  • Mild =
    • BP: >140/90 but less than 160/110
    • Proteinuria 300 mg => 5g /24-hr urine bg
    • or Single urine protein:Cr ratio of 0.3 mg/dL
  • Severe =
    • BP: >160/>110 on 2 occsaions 4 hours apart
    • Proteinuria of at least 5g /24-hr
    • or [3+ protein] on 2 random urine dips, at least 4 hours apart
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16
Q

What are some sx’s associated with preeclampsia which would put someone in the severe category?

A
  1. Oliguria (less than 500 mL in 24 hours) or renal insufficiency (serum Cr >1.1)
  2. Cerebral or visual disturbances
  3. Pulmonary edema
  4. Epigastric or RUQ pain (think subscapular hematoma)
  5. ↑ liver enzymes (2x UNL)
  6. Thrombocytopenia
17
Q

Management of Mild Preecmaplsia

A

Less than 37 wks:

  1. Bed rest
  2. Antepartum testing: BPP (1/week) or NST (2/week)
  3. Fetal growth US: every 3-4 wks
  4. Office visits and lab eval
  5. Possibly hospitalization

37 weeks => 40 weeks

  1. If cervix is favorable => induce
  2. If cervix is not favorable => cervical ripening to begin induction.
18
Q

Management of Severe Preeclampsia

A
  1. Manage BP with anti-HTN (Hydralazine, Labetalol, Nifedipine)
  2. Immediate hospitalization
  3. Delivery if more than 34 wks
  4. If less than 37 wks: administer corticosteroids and work toward delivery as long as pt and fetus are stable
19
Q

What is the management of mild preeclampsia at 37-40 weeks gestation?

A
  • If favorable cervix- induction
  • If unfavorable cervix - use a cervical ripening agent to begin induction
20
Q

What type of delivery is preferred in a patient with preeclampsia?

21
Q

_________ is adminstered for seizure prophlyxis

A

IV Magnesium sulfate

22
Q

When giving magnesium sulfate to patient with preeclampsia for seizure prophylaxis what is the loading dose and maintenance dose used; what should you be monitoring?

A
  • Loading dose = 4 gm bolus
  • Maintenance dose = 2 gm/hr
  • Monitor urine output and reflexes
23
Q

What is the theraputic value (mg/dL) for magnesium sulfate when using prophylactically in patient with preeclampsia?

A

5-9 mg/dL, but shouldnt give over 7-8

24
Q

How much Magnesium Sulfate will cause the following:

  1. Loss of patellar reflexes
  2. Respiratory paralysis
  3. Cardiac arrest
A
  1. > 9
  2. > 12
  3. > 30
25
Q

________ should be given to prevent overload of magnesium sulfate, which can cause respiratory compromise and cardiac arrest.

A

Fluid restriction (100mL/hr) and continue 24 hours after delivery

26
Q

_________ is given to REVERSE overload of Magnesium Sulfate.

A

Calcium gluconate

27
Q

What is the first thing to do in patient with eclampsia; what is the first line treatment?

A
  • First thing to do => protect the airway
  • Magnesium sulfate => first-line tx
28
Q

If the seizures of eclampsia are persistent after giving magnesium sulfate, what else can be given?

29
Q

Is ecclampsia an indication for C-section?

A

No, but fetus may need in-utero resuscitation time.

30
Q

What does HELLP syndrome stand for and is a variant of what?

A
  • Hemolysis, Elevated Liver enzymes and Low platelets

- Variant of preeclampsia

31
Q

How does HELLP syndrome affect patients

A

Complicates 4-12% of severely preeclamptic pts and up to 50% of eclamptic pts => RUQ pain, epigastric pain, N/V

32
Q

What is the indication for delivery in patient with HELLP syndrome?

A

HELLP syndrome => Immediate delivery

33
Q

In patient with hx of preeclampsia, especially if accompanied by an adverse outcome, multifetal gestation, chronic HTN, diabetes, renal or autoimmune disease, what is given as a preventative measure?

A

Baby ASPIRIN starting at 12 weeks

Endo/Repro II Test 1 (23 decks)

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