12- Maternal Emergencies After 20 weeks of Pregnancy and in the Peripartum Period Flashcards
Chronic Hypertension definition
SBP of >140mmHg or a DBP of >90 mmHg before 20th week of AOG or persists longer than 12 weeks postpartum
Definition of Gestational Hypertension
Hypertension present only after the 20th week of pregnancy or in the immediate postpartum period BUT WITHOUT PROTEINURIA
TRUE OR FALSE:
All antihypertensive drugs cross the placenta
TRUE
First-line agent for chronic hypertension in pregnancy (+ dose)
STARTING DOSE: Labetalol 100mg PO BID
MAINTENANCE DOSE: 200-400mg BID
Target BP for hypertensive pregnant women
140-150/90-100 mmHg
Medications for acute management of hypertensive emergencies
- Hydralazine 5mg IV or IM
- Labetalol 20mg IV
- Nifedipine 10-30mg PO
TRUE or FALSE:
ARBs and ACEis are contraindicated because of their teratogenic effects on fetal scalp, lungs, and kidneys
TRUE
Definition of Preeclampsia
Presence of de novo hypertension (>140mmHg SBP of >90mmHg diastolic) after 20 weeks of gestation combined with proteinuria (> or = 300 mg in 24h) or other maternal organ dysfunction (renal, liver, neurologic)
Severe features of preeclampsia
- SBP > or = 160mmHg or DBP > = 110mmHg on 2 occasions at least 4 hours apart while the patient is on bed rest
- Thrombocytopenia (<100,000 platelets/mL)
- Impaired liver function OR RUQ/epigastric pain unresponsive to medication
- Progressive renal insufficiency
- Pulmonary edema
- Cerebral or visual disturbances
Histologic hallmark lesion of preeclampsia
Acute atherosis of decidual arteries
Risk factors for preeclampsia
- Previous hx of preeclampsia
- Maternal age >40 yrs old
- HPN
- DM
- Renal disease
- Collagen vascular disease
- Multiple gestation
Only definitive resolution for preeclampsia
Delivery
Treatment of preeclampsia
Antihypertensives (labetalol, hydralazine, nifedipine)
IV Magnesium Sulfate
Definition of Eclampsia
Development of new-onset seizures, superimposed upon preeclampsia, in a woman between 20 weeks of gestation and 4 weeks postpartum
Treatment of seizures in patients with eclampsia
Magnesium Sulfate 4-6g IV in 100ml aliquot given over 20-30 minutes followed by an infusion of 2g per hr for at least 24 hours
Peak incidence of abruptio placentae (AOG)
24-32 weeks AOG
Risk factors for placental abruption
- Abdominal trauma
- Cocaine use
- Oligohydramnios
- Chorioamnionitis
- Advanced maternal age or parity
- Eclampsia
- Chronic or acute hypertension
Pathogens that increase the risk of PPROM (Premature preterm rupture of membtanes)
- Chlamydia
- Gonorrhea
- Trichomonas vaginalis
Remarks for Nitrazine test for PPROM
- Used to detect presence of amniotic fluid
- Blue color indicates pH of >6.5 which indicates the presence of amniotic fluid (positive)
Corticosteroids used for preterm births
- Bethamethasone 12mg IV q24 x 2 days
- Dexamethasone 6mg IV BID x 2 days
Antibiotics for PROM
- Ampicillin 2g IV Q6
- Erythromycin 250mg IV Q8
ALTERNATIVES:
Cefazolin 2g IV
Clindamycin
Vancomycin
Adverse side effect of Co-Amox and hence, primary reason for being contraindicated in cases of premature rupture of membranes
Necrotizing enterocolitis
TRUE or FALSE:
In a postpartum woman with fever, assume pelvic infection until proven otherwise
TRUE
Symptoms include: fever, foul-smelling lochia, leukocytosis, tachycardia, pelvic pain and uterine tenderness
Treatment of Postpartum Endometritis
- Clindamycin 900mg Q8 IV or 600mg IV Q6
- Aminoglycosides: Gentamicin 5mg/kg q24 or 1.5mg/kg q8)
