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OB GYNE 4 > 6 Hypertension in Pregnancy > Flashcards

6 Hypertension in Pregnancy Flashcards

1
Q

List the 5 Hypertensions in pregnancy

A
  1. Chronic or Essential hypertension
  2. Gestational hypertension
  3. Pre eclampsia
  4. Eclampsia
  5. HELLP Syndrome
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2
Q

Chronic or essential is when there is high blood pressure discovered _____ to the pregnancy. Meaning that the pregnancy itself is not the cause.

A

prior

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3
Q

The high blood pressure is found within the first ___ weeks of pregnancy.

A

20

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4
Q

Secondary causes of the high BP include (3)

A
  1. Renal disease
  2. Endocrine disorders
  3. Neurologic disorders
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5
Q

What hypertension occurs after 20 weeks?

A

Gestational Hypertension

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6
Q

Gestational hypertension is when the blood pressure is greater than __ occasions during pregnancy within __ hours of each other.

A

140/90 mmhg; 2; 6

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7
Q

gestational hypertension high blood pressure is found after the ___ week mark. The patient did not exhibit high BP before this mark.

A

20

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8
Q

With this type of hypertension there is no presence of protein in the urine and patients can be?

A

asymptomatic

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9
Q

Often gestational hypertension resolves within the first ___weeks of giving birth

A

12 weeks.

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10
Q

Patients with Gestational hypertension may have had high BP prior to the pregnancy and it may lead to

A

pre-eclampsia

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11
Q

Pre-eclampsia is though to be caused by

A

Prostaglandin abnormalities

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12
Q

Prostaglandins are a hormone like substance that participate in the following functions

A

Contraction and relaxation of smooth muscle
The dilation and constriction of blood vessels
control of blood pressure
modulation of inflammation

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13
Q

Pe-eclampsia occurs when there is an abnormal development of

A

blood vessels of the placenta in early pregnancy

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14
Q

With Pre-eclampsia oxygen supply to the fetus is?

A

reduced

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15
Q

In pre-eclampsia the spiral arteries remain rigid instead of becoming large and

A

tortuous

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16
Q

Pre-eclampsia occurs after __ weeks

A

20

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17
Q

What is the cause of pre-eclampsia ?

A

the placenta

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18
Q

When there is a decrease in oxygen to the placenta it releases inflamed molecules into the mothers blood stream and damages the

A

endothelial cells

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19
Q

The S & S of pre-eclampsia include (4)

A
  1. high BP 140/90mmHg after 20 week mark
  2. Protenuria
  3. Edema -swelling in the feet, hans and face
  4. rapid weight gain
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20
Q

In order for pre-eclampsia to be diagnosed

A

high blood pressure must be present with one of the other S&S.

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21
Q

HELLP Syndrome stands for ?

A

Hemolysis - (destruction of red blood cells)
Elevated Liver enzymes - (ongoing liver damage)
Low Platelets - (help blood clot)

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22
Q

A severe varient of pre-eclampsia

A

Abdominal pain due to hepatic hemorrhage

23
Q

Eclampsia occurs in women with severe

A

Pre-eclampsia

24
Q

Eclampsia is diagnosed when a women with pre-eclampsia has

A

seizures

25
Q

Aprox 30-50% of patients with pre-eclampsia also have the ___Syndrome

A

HELLP Syndrome

26
Q

Sonography in hypertension results in?

A

impaired circulation to the placenta

27
Q

Impaired circulation in the placenta results in (7)

A 
IUGR
Preterm labour
Placental abruption
Placental infarcts
Oligohydramnios
Decreased placental maturation
Fetal demise
28
Q

What marker if low is considered a MARKER FOR PRE-ECLAMPSIA ?

A

PAPP A

29
Q

A maternal blood test is performed at the first trimester screen in conjunction with the

A

Nuchal translucency

30
Q

A repeat ultrasound is performed at ___ weeks with ____

A

23-24 weeks ;Doppler

31
Q

Artery Doppler is performed to look for (2)

A
  1. Notching

2. low diastolic blood

32
Q

Protocol for hypertension in pregnancy

A
  1. BPP (for fetal well-being)
  2. Growth (2nd or 3rd, Biometery)
  3. Doppler of the umbilical artery
33
Q

Doppler - The umbilical artery normally is

A

LOW resistance

34
Q

Abnormal umbilical artery is High resistance artery is

A

Low or reversed diastolic flow

35
Q

What is the preferred method of measurement with umbilical artery doppler

A

Pulsatility index (PI)

36
Q

When there is restriction to placental blood flow a loss of _______ frequency occurs or it is reversed

A

end-diastolic

37
Q

THE MCA normally is

A

high resistance

38
Q

Low resistance has an increased _____ flow

A

diastolic

39
Q

When the MCA has impedence to blood flow the placenta has

A

low resistance

40
Q

When there is placental insufficiency the fetus adapts by

A

vasodilation

41
Q

With Hypoxia _____vasodilation occurs and once

A

cerebral

42
Q

Once vasodialtion from hypoxia is exhausted the diastolic flow will start to

A

increase

43
Q

The ______ can also be used as a screening tool

A

ductus venous

44
Q

The ductus venosus is the main vessel which ____ blood returning from the placenta is directed to the ____ and ____

A

oxygenated ; fetal heart and circulation

45
Q

In a normal fetus the ductus venosus demonstrates what appearance?

A

triphasic

46
Q

With worsening fetal hypoxia there is a redistribution of high oxygenated umbilical vein blood through the ductus venosus to the fetal heart . when critical an ____ in ____ and during atrial contraction there is ______flow

A

increase; Peak systolic forward flow ; retrograde

47
Q

Women with high risk of pre-eclampsia are screen using doppler indices for the _____

A

Uterine artery

48
Q

Abnormal indices of the uterine artery result from?

A

increase resistance to flow

49
Q

Often a ____ resistance waveform is associated with low change of pregnancy complications

A

low

50
Q

high resistance waveform with ____ present at the end of systole and reduced end diastolic frequencies are associated with higher rate of pregnancy complications

A

notching

51
Q

Notching in late pregnancy is an indicator of ?

A

increased uterine resistance and poor uterine circulation.

52
Q

Treatment for Hypertension

A
  1. Bed rest
  2. Medication
  3. Monitoring mom and baby
53
Q

What is the only was to reverse the process?

A

Delivery

54
Q

Medication in pregnancy can cause (3)

A

fetal addition, IUGR and teratogenic defects

OB GYNE 4 (11 decks)

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