ch 27 OB complications (HTN, endocrine) Flashcards
4 HTN disorders
-gestational HTN
-preeclampsia
-eclampsia
-chronic HTN
maternal consequences of HTN
-hepatic, renal, cardiac dysfunction/failure
-placental abruption
-coagulopathy/DIC
-cerebral hemorrhage
-pulmonary edema
-seizures
-stroke
-death
causes perinatal morbidity relating to HTN
-uteroplacental insufficiency
-premature birth
-death
UPI
uteroplacental insufficiency
Development of hypertension after week 20 of pregnancy in a previously normotensive woman
*without proteinuria or other systemic findings
gestational hypertension
what mmHg is considered HTN
> 140/>90
on 2 separate occasions atleast 4 hours apart
Development of hypertension and proteinuria in a previously normotensive woman after 20 weeks of gestation or in the early postpartum period
*with proteinuria or w/o proteinuria but other complications
preeclampsia
low platelets
thrombocytopenia
other complications with preeclampsia if woman doesn’t have proteinuria
-thrombocytopenia
-renal insufficiency
-impaired liver function
-pulmonary edema
-cerebral/visual symptoms
what are severe features of preeclampsia (7)
-BP >160/>110
-Plt < 100 K
-Impaired liver function
-Renal insufficiency
-Pulmonary edema
-New onset Headache unresponsive to med & not due to alternate dx
-Visual Disturbances
onset of seizure activity or coma in woman with preeclampsia
eclampsia
Hypertension in a pregnant woman present before pregnancy
chronic HTN
when does preeclampsia begin to resolve
after delivery of placenta
what doesn’t happen with woman with preeclampsia concerning spiral arteries
spiral arteries don’t dilate and straighten
less blood flow to placenta
risk of UPI
consequences at the cellular level of preeclampsia
-increased endothelial cell permeability (proteins and fluid go to ECF)
-increased blood concentration (increased RBCs and Hct)
-affects kidneys ability to reabsorb (causing proteinuria)
-nondependent edema (possibility for every organ swells)
-vasospasm
-decreased organ perfusion
-thrombocytopenia (platelet buildup in cells)
-*oliguria
-retinal arteriospasms (visual disturbances)
-DIC (micro-clots everywhere)
preeclampsia:
-what could cause increased RBC/Hct?
-what could cause decreased RBC/Hct?
-increased: increased blood concentration due to fluids going to ECF
-decreased: platelet buildup in cells tears up RBCs
DIC
disseminated intravascular coagulation
(body uses up all of clotting factors to patch up leaky blood vessels)
variant of severe preeclampsia
HELLP syndrome
what is included in HELLP syndrome for preeclampsia
-H: Hemolysis (decreased Hct)
-EL: elevated liver enzymes (hepatic dysfunction)
-LP: low platelets (<100,000)
variant of preeclampsia that may not have increased bp
HELLP syndrome
S+S HELLP syndrome (not labs)
-malaise
-epigastric/RUQ pain
-N/V
Tx HELLP syndrome
magnesium sulfate therapy
high risk factors preeclampsia (6)
-Hx preeclampsia
-multifetal pregnancy
-chronic HTN
-pregestational diabete (T1 or T2)
-renal disease
-autoimmune disease
moderate risk factors preeclampsia (6)
-primigravida
-maternal age >35 yo (previously included <19 yo)
-BMI >30 yo
-family h/o preeclampsia
-socio-demographic characteristics (non-white)
-personal history factors