8-Hypertension In Pregnancy

Question 1

What are the types of hypertension ?

Answer 1

Gestational hypertension

Pregnancy induced hypertension(PIH)

Question 2

What is considered hypertension?

Answer 2

Increase in BP without proteinuria > 20 weeks
Systolic>140 mm Hg
Diastolic>90 mm Hg
Patient previously normotensive

Question 3

What are the classic triad of preeclampsia?

Answer 3

Hypertension
Proteinuria
Edema- present in1/3 of pregnant women
Other symptoms are visual disturbances,headache, epigastric pain

Question 4

What is the criteria for diagnostic of severe preeclampsia ?

Answer 4

Systolic BP>160 mm Hg
Diastolic BP>110 mm Hg
2 readings done 6 hours apart
Treatment needs to be started before diagnostic to avoid patient reaching stroke level

Question 5

What are the proteinuria level for diagnosis?

Answer 5

> 5 grams/24 hour urine specimen
3+ on two random urine samples @ least 4 hours apart
Oliguria<500 cc/24 hours

Question 6

What are other lab abnormalities for diagnosis?

Answer 6

If pt BP is not indicative of preeclampsia
Hemolysis
Elevated liver enzymes
Low platelets counts

Question 7

What are the causes of preeclampsia?

Answer 7

Abnormal trophoblastic invasion ( when the egg implants)
Alterations in the immune response
Unknown

Question 8

What are the criteria for diagnosis of eclampsia ?

Answer 8

Convulsions/coma
Signs and symptoms of preeclampsia
No other reason for seizure

Question 9

What are the sign and symptoms of eclampsia?

Answer 9

Elevated BP
Increase proteinuria (4+)
Generalized edema
Increase patellar reflexes (4+)
New onset seizure activity may be first sign

Question 10

What are the risk factors for preeclampsia/eclampsia ?

Answer 10

Multiple gestation 
Preeclampsia in previous pregnancy
Chronic HTN
Gestational diabetes
Vascular/ connective tissue disease
Pt>35 years
African american

Question 11

What are the vascular changes in preeclampsia ?

Answer 11

Hemoconcentration
Vasospasm
Capillary leak
Decrease colloid oncotic pressure

Question 12

What are the hematologic changes?

Answer 12

Thrombocytopenia
Hemolysis
Change in hematocrit level
Increase in hematocrit indicates worsening of the disease

Question 13

What are the hepatic changes?

Answer 13

Increase ALT, AST
Hepatic hemorrhage
Hepatic rupture- rare and high mortality rate

Question 14

What are the neurologic / cerebral problems associated?

Answer 14

Intracranial hemorrhage is the major reason for death
Temporary blindness
Hyperreflexia

Question 15

What are the fetal changes associated?

Answer 15

Decrease uteroplacental blood flow
Placenta infarction
IUGR
Placental abruption

Question 16

How to manage preeclampsia?

Answer 16

Delivery of infant is the only cure

Delivery depends on gestational age of fetus, maternal/fetus status and presence of labor

Question 17

What are the medications for management of preeclampsia?

Answer 17

The primary concerns are to avoid seizure activity and cerebrovascular accidents
Drug of choice in the USA is magnesium sulfate to prevent seizures
Hydralazine (5-10 mg IV Q15-20 min) for treatment of HTN
Labilatol with increasing dosage also for HTN