19: Hypertensive Disorders in Pregnancy

Question 1

Chronic hypertension

Answer 1

Present before or recognized during first half of pregnancy

Question 2

Gestational hypertension

Answer 2

Recognized after 20 weeks gestation

Question 3

Preeclampsia

Answer 3

Occurs after 20 weeks gestation and coexists with proteinuria

Question 4

Eclampsia

Answer 4

New onset seizure activity associated with preeclampsia

Question 5

Superimposed preeclampsia/eclampsia

Answer 5

Transposed onto chronic hypertension

Question 6

Treatment of mild chronic hypertension

Answer 6

Initiate antihypertensive, antepartum fetal monitoring, delivery between 39-40 weeks gestation

Question 7

Treatment of severe chronic hypertension

Answer 7

Antihypertensive therapy (methyldopa, labetalol, nifedipine) - NO ACE INHIBITORS; antepartum fetal surveillance; delivery after 38 weeks gestation

Question 8

Diagnosing factors and symptoms in preeclampsia

Answer 8

Diagnosis: HTN, proteinuria, edema
Sx: scotoma, blurred vision, RUQ pain, HA

Question 9

Mild preeclampsia

Answer 9

BP greater than 140/90 but less than 160/110

Proteinuria > 300 mg/24 hour urine but less than 5 gms/24 hour urine; protein:creatinine ratio of 0.3 mg/dL

Question 10

Severe preeclampsia

Answer 10

BP greater than 160/110; proteinuria of at least 5 gm/24 hour or 3+ protein on 2 random urine dips

Question 11

Magnesium sulfate

Answer 11

IV administration for severe preeclampsia. Loading dose 4 gm bolus, maintenance does 2 gm/hr
Therapeutic value 5-9 mg/dL

Question 12

Treatment of eclampsia

Answer 12

Protect airway, Magnesium sulfate is 1st line tx

Question 13

HELLP syndrome

Answer 13

Complicates some severely preeclamptic patients and 50% eclamptic patients