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OBGYN > 8: HTN > Flashcards

8: HTN Flashcards

1
Q

Preeclampsia is the presence of ? and ?

A

hypertension >140/90 mm Hg (2x 6hrs apart) and proteinuria > 300 mg/24 hours or or >1 to 2> on dipstick (+/- nondependent edema)
-most common in nulliparous in her 3rd trimester

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2
Q

Preeclampsia is characterized by generalized multiorgan vasospasm that can lead to ?

A

seizure, stroke, renal failure, liver damage, pulmonary edema, DIC/thrombocytopenia, or fetal demise.

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3
Q

Risk factors for preeclampsia include ?

A

nulliparity, multiple gestation, and chronic hypertension.

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4
Q

patients present with eclamptic seizures occurring ?

A

before labor (25%), during labor (50%), or after delivery (25%).

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5
Q

Chronic hypertension is defined as hypertension occurring when?

A

before conception, before 20 weeks’ gestation, or persisting more than 6 weeks postpartum

  • leads to superimposed preeclampsia in one-third of patients.
  • tx with nifedipine or labetalol (NOT methyldopa)
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6
Q

what tests for suspected preeclampsia

A

A baseline ECG and 24-hour urine collection for protein and creatinine should be performed.

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7
Q

severe preeclampsia is defined as ? and ?

A

BP>160/110, protein >5g/24hrs (3-4+ on dipstick) and s/s of severe preeclampsia (detailed later)

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8
Q

When hypertension is seen early in the second trimester (14 to 20 weeks), consider ?

A

hydatidiform mole or previously undiagnosed chronic hypertension

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9
Q

Unlike other preeclamptic patients, the patient with HELLP is more likely to be less than ? weeks at time of presentation

A

36 weeks

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10
Q

HELLP typically presents with

A

RUQ pain, epigastric pain, or N/V in the 3rd trimester

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11
Q

HTN states of pregnancy

A 
GH (or pregnancy-induced hypertension)
Preeclampsia
Severe preeclampsia
Chronic hypertension
Chronic hypertension w/superimposed preeclampsia
HELLP syndrome
AFLP
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12
Q

fetal complications of preeclampsia

A 
*Complications related to prematurity (if early delivery is necessary)
Acute uteroplacental insufficiency
Placental infarct and/or abruption
Intrapartum fetal distress
Stillbirth (in severe cases)
Chronic uteroplacental insufficiency
Asymmetric and symmetric SGA fetuses
IUGR
Oligohydramnios
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13
Q

obstetric complications of preeclampsia

A

Uteroplacental insufficiency
Placental abruption
Increased premature deliveries
Increased cesarean section deliveries

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14
Q

disease-related risk factors for preeclampsia

A 
Chronic hypertension
Chronic renal disease
Collagen vascular disease (e.g., SLE)
Pregestational diabetes
African American
Maternal age (35)
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15
Q

immunogenic-related and fam hx risk factors for preeclampsia

A 
Nulliparity
Previous preeclampsia
Multiple gestation
Abnormal placentation
New paternity
Female relatives of parturient
Mother-in-law
Cohabitation
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16
Q

If a diagnosis of preeclampsia is being made in the acute setting, what urine dip can be diagnostic?

A

proteinuria of 1+ or greater on a clean catch urine dipstick on two occasions has also been used to diagnose proteinuria.
if 2+, 24 hr urine typically >300mg

17
Q

is a negative/trace urine dip reassuring if pt is hypertensive?

A

No, more than 2/3 of patients with elevated BPs and negative or trace on urine dip had >300 mg/ 24 hr and all patients with 3+ and 4+ protein on urine dip had significant proteinuria on a 24 hour urine protein
-a better predictor than dip is PCR ratio

18
Q

A spot urine P/C ratio of ? is concerning for preeclampsia and should prompt further evaluation, including ?

A

0.2 to 0.3

a 24 hour urine protein collection.

19
Q

severe preeclampsia by systems

A

Neuro: severe headache (not relieved by acetaminophen)
Visual changes; scotomata
Cardiovascular: SBP >160 mm Hg or DBP >110 mm Hg
Pulmonary: Pulmonary edema
Renal: Acute renal failure with rising creatinine
Oliguria 3+ on dipstick
GI: RUQ pain
Elevation of transaminases, AST and ALT
Heme: hemolytic anemia
Thrombocytopenia:

20
Q

many clinical symptoms of preeclampsia are explained by ?

A

-vasospasm (and intravascular depletion secondary to a generalized transudative edema) leading to ischemia, necrosis and hemorrhage of organs.

21
Q

diagnose of HELLP

A

hemolytic anemia: Schistocytes on PBS, Elevated LDH, Elevated total bilirubin
Elevated liver enzymes: increase in AST and ALT
Low platelets: thrombocytopenia (less than 100,000)

22
Q

a number of AFLP patients will have fetuses with deficiency of ?

A

long-chain hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency

23
Q

To differentiate AFLP from HELLP

A

AFLP (liver failure): elevated ammonia level, blood glucose

24
Q

Mg sulfate dosage for mild preE seizure ppx during L/D (and 12-24 hrs after delivery)

A

4 g load and 1 g/hour maintenance, or 4 or 6 g load and 2 g/hour maintenance regimen.

25
Q

severe preE management

A

Mg sulfate, hydralazine (a direct arteriolar dilator) or labetalol (beta and alpha blockade)
-Beyond 32 wga or in a severe preeclamptic patient with signs of renal failure, pulmonary edema, hepatic injury, HELLP syndrome, or DIC, delivery should ensue immediately.

26
Q

severe preE treatment after delivery

A
  • may worsen due to ^Ag exposure, Mg ppx 24 hrs after
  • if BP chronically elevated: nifedipine and labetalol
  • if HELLP with worsening thrombocytopenia: corticosteroids
27
Q

theorized tx to prevent preE in subsequent pregnancies

A

ASA and Ca2+

28
Q

eclampsia complications

A

(+seizures: tonic-clonic/grand mal) cerebral hemorrhage, aspiration pneumonia, hypoxic encephalopathy, and thromboembolic events.

29
Q

when is MgSO4 initiated in eclampsia?

A

at the time of diagnosis and continued for 12 to 24 hours after delivery

30
Q

In the case of MgSO4 overdose, rapidly administered ?

A

10 mL 10% calcium chloride or calcium gluconate IV for cardiac protection.

31
Q

Clinical Response to Serum MgSO4 Concentrations

A

4.8–8.4: Therapeutic seizure prophylaxis
8: CNS depression
10: Loss of DTRs
15: Respiratory depression/paralysis
17: Coma
20–25: Cardiac arrest

32
Q

delivery should be initiated in eclamptic pt only after ?

A

patient has been stabilized and convulsions have been controlled

  • stabilize the mother by establishing adequate maternal oxygenation and cardiac output
  • may see prolonged FHR decels
33
Q

An increase in the SBP/DBP of ? over pre pregnancy BP is indicative of superimposed preeclampsia

A

SBP >30 mm Hg or in the DBP >15 mm Hg

34
Q

in a patient with renal disease, an elevated ? is sometimes used to differentiate preeclampsia from exacerbation of HTN

A

uric acid above 6.0 to 6.5

35
Q

chronic HTN leads to superimposed preE in ? of patients

A

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OBGYN (28 decks)

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