Ch 47 Chrinic Hypertension Flashcards
Dx of chronic gyn made whenever gyn precedes pregnancy or occurs prior to 29 weeks ga.
T
Women with chronic gyn are at considerably increased risk for superimposed preeclampsia, which in turn substantially increases risks for preterm delivery and other pregnancy complications such as
Abruptio placentae
And fetal growth restriction
Risk of maternal hemorrhage I ceases from 10 in 100,000
To 230 in 100,000
In women with chronic hypertension
T
Incidence of abruption increases from 1 in 200 to 300 nonhypertensice women to
1 in 50 with mild htn
To 1 in 12 in women with severe gyn
Smoking furthers this risk
T
Superimposed preeclampsia
Women with chronic htn are at increased risk for superimposed htn
Incidence of fetal growth restriction occurs in direct relation to the severity of
Maternal hypertension
Advanced maternal age, severity of htn, need for additional antihypertensive medication, presence of end organ damage such as renal or cardiac dysfunction, add to the risk of fetal growth restriction
T
Prehypertension: 120-139 / 80-90
Stage 1 htn: 140-159 / 90-99 ( treat with thiazide - type diuretics for most. May consider ace inhibitor, arb, bets blocker, ccb , or both)
methyldopa (thiazide)labetalol ( beta blocker)and long-acting nifedipine (ccb) as acceptable oral antihypertensive
Stage 2 htn: >= 160 /100
(Two drug combination for most usually thiazide type diuretic and acei, arb, bblocker, or ccb)
T
Recommend behavioral modification dietary consult, reduction of smoking, alcohol, cocaine, or substance abuse.
Begin anyibypertensive treatment in an otherwise healthy woman with persistent diastolic pressures of 100mghg or greater
T
Although antihypertensive meds beneficial
To
Mother, lower pressure could theoretically decrease uteriolacental
Perfusion and jeopardize fetus
T
Preconception and early pregnancy evaluation in women with chronic htn includes assessment of
Renal
Hepatic
Cardiac function
Cardiac assessment should be targeted toward asxertainment of any dysrhythmias or evidence of left ventricular hyper trophy, indicating longstanding or poorly controlled hypertension, or both. Women with appreciable left ventricular hypertrophy are at increased risk for cardiac dysfunction and congestive heart failure during pregnancy. In women with prior adverse outcome, or in long term htn, echocardiography is indicated.
Renal function is assessed by serum CREATININE and quantification of PROTEINURIA. If either is abnormal, hear women are at further increased risk for adverse effects on pregnancy
Pregnancy is contraindicated in women who despite therapy, maintain persistent diastolic pressures of 110mmhg or greater, require multiple antihypertensive, or whose serum creatinine is greater than 2ng/dL
Recommended antihypertensive sin pregnancy
Methyldopa -safe
Andrenergic - labetalol
Atenolol - association with fetal growth restriction
Diuretics not first line therapy during pregnancy esp after 20 weeks- fear that diuretics would decrease circulating blood volume and predispose to placental insufficiency
Angiotensin-converting enzyme inhibitors associated with malformations
Healthy women with mild htn have increased risk
Of
Abruptio placentae
Preterm delivery
Fetal growth restriction
Dx of superimposed preeclampsia
Difficult to make in women with hronic htn.
Criteria that support development of proteinuria; worsening of preexisting proteinuria; neurological symptoms including severe headaches and visual disturbances; oligouria, ic bullion’s, pulmonary edema
Laboratory abnormalities:
Increasing serum creatinine
Thrombocytopenia (<100,000)
Elevation of serum hepatic transaminase levels
