8. HTN & Pregnancy

Question 1

Hypertensive States of Pregnancy (7)

Answer 1

• Gestational Hypertension (or pregnancy-indcued HTN)
• Preeclampsia
• Severe preeclampsia
• Chronic HTN
• Chronic HTN w/ superimposed preeclampsia
• HELLP syndrome
• AFLP

Question 2

Gestational HTN

vs

Mild Preeclampsia

vs

Severe Preeclampsia

Answer 2

• BPs elevated above 140/90
• BPs should be elevated on at least 2 occasions 4 to 6 hours apart and taken while pt is seated
• If pt’s 24 hr urinary protein total is less than 300 mg, then preeclampsia can be r/o

Question 3

HELLP Syndrome

Answer 3

Characterized by rapidly deteriorating liver function and thrombocytopenia

Liver capsule distention produces epigastric pain, often with progressive nausea, vomiting –> hepatic rupture

Question 4

Acute Fatty Liver of Pregnancy

Answer 4

Unclear whether AFLP is truly in the spectrum of preeclamptic syndromes or an entirely separate entity with similar S&S

More than 50% of pts with AFLP will also have HTN and proteinuria

To differentiate AFLP from HELLP, lab tests associated with liver failure such as an elevated ammonia level, blood glucose less < 50 mg/dL, and markedly reduced fibrinogen and antithrombin III levels have been associated with AFLP

Question 5

Treatment

• Mild Preeclampsia
• Severe Preeclampsia

Answer 5

Treatment

• Mild Preeclampsia:
  
  • Expectant mgmt –>
    
    • betamethasone to enhance fetal lung maturity
    • magnesium sulfate for seizure prophylaxis
• Severe Preeclampsia
  
  • Deliver

Question 6

Chronic HTN:

Pathogenesis

Treatment

Answer 6

Pathogenesis:

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

Treatment:

• Labetalol (bb w/ concomitant alpha blockade) and nifedipine (CCB)