13. Hypertensive Disorders in Pregnancy

Question 1

HTN complicates 12-22% pregnancies, maternal risks include myocardial infarction, death, cerebral vascular accident, pulmonary edema, renal failure, preeclampsia, gestational diabetes, cesarean delivery, fetal complications include fetal growth restriction, preterm birth, placental abruption, still birth, death and ?

Answer 1

congenital anomalies (heart defects, hypospadias, and esophageal atresia)

Question 2

Elevated BP: 120-129/<80
Stage 1: 130-139/80-89
Stage 2: 140+/90+
What is recognized as 180/120+ with patients needing prompt changes in meds if there are not other indications of problems or immediated hospitalization?

Answer 2

Hypertensive Crisis

Question 3

Causes of chronic HTN include idiopathic (89%), vascular disorders(reno-vascular), endocrine DOs (DM), renal disorders (diabetic nephropathy), CT disorders like SLE, take pressure after pt is rested for 10 mins, legs uncrossed, back supported, must use and appropriate size?

Answer 3

CUFF one with a length 1.5 times upper arm cirucmference

Question 4

Chornic HTN eval: r/o disorders, asses for end organ changes: CBC, glucose, CMP, 24 hour urin collection for protein, EKG, echo, asses for fetal well being: US, screening US, growth US monthly after 28 weeks, and antepartum fetal testing to begin at what weeks?

Answer 4

32-34weeks

Question 5

Mild HTN (less than 160/110) management includes aspirin therpay (81mg) at 12 weeks till delivery, give antiHTN if threshold reached, prenatal visits q 2-4 weeks until 34-36 weeks then weekly, antepartum fetal monirotin and delivery?

Answer 5

39-40 weeks _ TERM

Question 6

Severe HTN (>160/110) management include anti HTN meds including methyldopa, labetolol, nifedipine**, are all first line, what should be avoided in pregnancies for antiHTN due to increased risk of malformations such as renal dysgenesis, calvarial hypoplasia and FGR?

Answer 6

ACE inhibitors and Angiotensin receptor blockers

Question 7

Severe HTN (>160/110) management includes close prenatal monitoring, 24 hour urine q trimester, observation for superimposed preeclampsia, fetal surveillance with growth US q 3-4 weeks, NST/BPP, delivery early at?

Answer 7

38 weeks

Question 8

Gestation DM GDM is HTN without proteinuria after 20 weeks or with 48 hours of preg, resolves 12 weeks postpartum. What is diagnosed via HTN, proteinuria and edema, with symptoms including scotoma, blurred vision, epigastric or RUQ and headache?

Answer 8

Preeclampsia

Question 9

Preeclampsia risk factors include young or old age, primigravid, multiple gestation, hydatidiform mole, DM, BMI>30, chronic HTN, renal disease, Collagen vascular disease (SLE), Antiphopholipid syndrome, prio hx of Preeclampsia, assisted reproductive technoloy and obstructive ?

Answer 9

sleep apnea

Question 10

Preeclampsia causes headache due to cerebral edema (headache), may find fibrinoid necrosis, thrombosis, microinfarcts and petechial hem, also causes heart issues (edema)- absence of normal intravascular volume expansion (3rd spacing), reduction in circulating BV, and causes what in lungs?

Answer 10

Pulmonary Edema changing colloid osmotic pressure, capillary endothelial integrity and intravascular hydrostatic vessels (leaking!)

Question 11

Preeclampsia in the liver causes RUQ due to sinusoidal fibrin deposition in periportal area with surrounding hemorrhage and portal capillary thrombi causing subcapsular hematoma and?***

Answer 11

liver rupture = medical emergency

Question 12

Preeclampsia in the kidneys causes swelling and ennlargement of glomerular capillary endothelial cells and narrowing of the capillary lumen (proteinuria/edema) and eyes affected causes retinal vasospasm and retinal edema leading to?

Answer 12

Vision changes

Question 13

Preeclampsia etiology is UNKNOWN - path will tell you some propositions, what do we do with the baby?

Answer 13

DELIVER

Question 14

Mild Preeclampsia (Preeclampsia without severe features) is BP>140/90 but less than 160/110, asymptomatic and proteinuria is greater than what in 24 hour urine but less than 5gms, or a single specifimen urine protein:creatinine ratio of 0.3?

Answer 14

Proteinuria >300, <5gms

Question 15

Severe Preeclampsia(Preeclampsia with severe features) includes BP>160/110, proteinuria at least 5gm/hour or 3+ protein, oliguria, renal insufficiency, liver enzymes 2x upper limits, + RUQ pain, pulmonary edema, symptomatic: cerebral or visual disturbances, pulm edema, RUQ pain, elevated liver enzymes and?

Answer 15

thrombocytopenia

Question 16

Preeclampsia exam findings include brisk reflexes, clonus, edema, and labs include INCREASED hematocrit, lactate dehydrogenase, transaminases (AST/ALT) uric and and thrombocytopenia meaning that what is low?

Answer 16

Platelets

Question 17

Managment of mild Preeclampsia includes (under 37weeks) once BPP or twice NST weekle antepartum testing, Fetal growth US q 3-4 weeks, possible hospitalization, 37-40weeks if favorible - INDUCE, in unfavorable cervix- use what?

Answer 17

cervical ripening agent to begin delivery and get dat bb out

Question 18

management of severe Preeclampsia include IMMEDIATE hospitalization, delivery if greater than 34 weeks, antHTNs- hydralazine, labetalol, nifedipine, if less than 37 weeks administer WHAT, and work towards delivery as long as patient and fetus are STABLE?

Answer 18

Corticosteroids

Question 19

Intrapartum management is vaginal delivery is preffered, used cervical ripening agents and pitocin, mag sulfate for seizure prophylaxis (neuroprotection against cerebral palsy), pain management with any delivery unless what, - may not be able to receive epidural?

Answer 19

Thrombocyotpenia

Question 20

What is administered IV for Preeclampsia with severe features for seizure prophylaxis, can overload and result in respiratory compromise and cardiac arrest, fluid restriction to prevent overload, continue for 24 hours after delivery?

Answer 20

Magnesium Sulfate

Question 21

What causes seizures that lasts 1-2 minutes, and occurs within 24 hours of delivery, first thing to do is protect airway, mag sulfate administration is first line tx, may need lorazepam, not an indication for ceserean delivery?

Answer 21

Eclampsia

Question 22

What is a variant of Preeclampsia and stands for hemolysis, elevated liver enzymes, and low platelets, RUQ pain, epigastric pain, N/V are common, Labs shows LDH greater than 600, AST/ALT elevated 2x upper limit, platlets less than 100,000- IMMEDIATE DELIVERY?

Answer 22

HELLP Syndrome