Chapter 11: Hypertensive Disorders of Pregnancy

Question 1

Hypertensive Disorders Contribute to what?

Answer 1

stillbirth and neonatal morbidity and mortality and can result in maternal cerebral hemorrhage, disseminated intravascular coagulation (DIC), hepatic (liver) failure, acute renal (kidney) failure, pulmonary edema, adult respiratory distress syndrome, aspiration pneumonia, and abruptio placentae

Question 2

Classifications

Answer 2

• Chronic hypertension
• Preeclampsia/ eclampsia
• Preeclampsia superimposed on chronic hypertension
• Gestational hypertension
• Transient Hypertension

Question 3

Chronic Hypertension

Answer 3

hypertension that is present and observable before pregnancy or hypertension that is diagnosed before the 20th week of gestation and persists beyond the 84th day postpartum
-systolic BP: > than or equal to 140 mm Hg
-diastolic BP: > than or equal to 90 mm Hg
>women with gestational hypertension who remain hypertensive postpartum are diagnosed as having chronic hypertension

Question 4

Preeclampsia

Answer 4

pregnancy-specific syndrome

• increase in BP (i.e. systolic BP greater than or equal to 140 mm Hg and diastolic greater than or equal to 90 mm Hg, respectively, occurring twice, 4 hours apart) after 20 weeks gestation
• accompanied by proteinuria (excretion of greater than or equal to 300 mg protein/24 hours)
• can also have edema (but this is a normal finding in pregnancy, but preeclampsia should still be ruled out)

Question 5

Eclampsia

Answer 5

the presence of new-onset grand mal seizures (and/or unexplained coma) in a woman with preeclampsia who has no other cause for seizure

Question 6

Preeclampsia Superimposed on Chronic Hypertension

Answer 6

preeclampsia may occur in woman who are already hypertensive
-Criteria:
>Hypertension and no proteinuria prior to 20 weeks gestation and new-onset proteinuria, (urinary excretion of 0.3 g of protein in a 24-hour specimen)
or
>Hypertension and proteinuria before 20 weeks gestation:
1. a sudden increase in protein–urinary excretion of 0.3 g protein or more in a 24 hour specimen, or two dipstick test results of 2+ (100 mg/dL), with the values recorded at least 4 hours apart, with no evidence of UTI
2. a sudden increase in BP after a period of good control
3. Thrombocytopenia (platelet count lower than 100,000/ mm3)
4. an increase in liver enzyme alanine transaminase (ALT) or aspartate transaminase (AST) to abnormal levels

Question 7

Gestational Hypertension

Answer 7

blood pressure elevation occurring after mid-pregnancy but without proteinuria
-temporary
-term used only during pregnancy until a more specific diagnosis can be made postpartum
>women with gestational hypertension who remain hypertensive postpartum are diagnosed as having chronic hypertension)

Question 8

Transient Hypertension

Answer 8

describes woman who develop gestational hypertension but have no preeclampsia and whose blood pressure returns to normal within 12 weeks postpartum
-term used only after pregnancy