Chapter 24 Preeclampsia Flashcards
preeclampsia definition:
new onset hypertension after 20 weeks gestation. in the presence of new onset PROTEINURIA.
etiology of preeclampsia
women with family hx of preeclampsia
father of baby who’s mother had preeclampsia are more likely to have pregnancies complicated by preeclampsia.
hypertension and diabetes, poor control of diseases with endothelial dysfunction;
women with history of preeclampsia.
increases risk of preeclampsia
women with hx of preeclampsia are more likely to develop
cardiovascular disease, renal disease, insulin resistance later in life (all involve endothelial dysfunction)
Risk FActors for Preeclampsia
1.nulliparity, primipaternity, and initial or novel sperm exposure.
2.previous hx preeclampsia; hx severe preeclampsia in 1st pregnancy increase risk of recurrence by 45%
3. Severe preeclampsia in midtrimester carries a recurrence rate as high as 65%
4. Family hx preeclampsia carries 3 x increased risk, and 4x increased risk of SEVERE preeclampsia.
5.chronic HTN, obesity, insulin resistance/diabetes mellitus.
stress
6.smoking (decreases risk of preeclampsia)
diagnosis of preeclampsia
new onset of systolic BP of at least 140/90 on 2 occassions at least 6 hrs but no more than 7 hrs apart.
diagnosed after 20 weeks in a previously normotensive patient.
Severe preeclampsia
160/ 110 for at least 6 hrs
proteinuria greater than
greater than or equal to 300mg in 24 hrs for mild preeclampsia and greater than or equal to 5 grams in 24 hrs for severe preeclampsia.
when 24 hr urine collection is not available, ___ can be used
urine dipstick can be used and proteinuria defined as at least 1+ on at least 2 different specimens 6 hrs apart. urine dipstick values should not be used to diagnose severe proteinuria.
symptoms of SEVERE preeclampsia:
persistent cerebral symptoms such as headache/vision changes, epigastric/right upper quadrant pain.
lab abnormalities of SEVERE preeclampsia
abnormal liver enzymes and thrombocytopenia with platelets <100,000.
end organ involvement sx: for SEVERE preeclampsia.
oliguria, pulmonary edema, fetal IUGR
diagnosis of SUPERIMPOSED preeclampsia
no previous proteinuria who develops proteinuria (at least 300mg in 24 hrs).
- preexisting proteinuria before 20 weeks gestation with new exacerbation of previously well-controlled HTN with systolic bp of 180mmHg or more or diastolic bp of 110mmhg or more.
- headache, vision changes, eigastric pain, elevations in liver enzymes, or decrease in platelets to <100,000 lead to dx of superimposed preeclampsia.
- Hemolysis elevated liver enzymes low platelets (HELLP).
HELLP
hemolysis - microangiopathic hemolytic anemia- presents with abnormal peripheral smear, elevated indirect serum bilirubin, low serum haptoglobin levels, elevated lactate dehydrogenase (LDH) (usually over 600). and SIGNIFICANT drop in hemoglobin levels.
rate of eclampsia (convulsions)
<1%
increased morbidity includes
convulsions pulmonary edema acute renal failure acute liver failure lier hemorrhage stroke disseminated intravascular coagulopathy.
management of mild preeclampsia:
at term (at least 37 weeks), delivery procedures should be initiated
mildly elevated blood pressures <160mmHg systolic do not need treatment
true
management of mild preeclampsia before 37 wks:
- manage expectantly until signs of severe preeclampsia, fetal maturity is documented, or 37 weeks.
- no evidence for efficacy of bedrest
- daily fetal movement counting and 2x NSTs OR weekly BPP until delivery
- frequent assessment of symptoms, blood pressure monitoring, and at least weekly laboratory evaluation.
- assessment of fetal growth every 3-4 weeks.
management of Severe preeclampsia:
- > or = 34 weeks delivery procedures should be initiated.
- proceed with delivery regardless of gestational age when eclampsia is imminent as indicated by persistent somatic symptoms (headache/ abd pain) or if there is multiorgan dysfunction, severe fetal growth restriction, suspected placental abruption , or NRFT
administer steroids for women with preeclampsia under 34 weeks of gestational age to enhance fetal pulmonary maturity, even if only as few as 4 hrs are expected from the first dose until delivery
true!
Magnesium sulfate for seizure prophylaxis is administered to pts > or = 34 weeks or greater and continued until 24 hrs postpartum.
true
severe HTN (> or = 160 or > or = 90 diastolic) requires aggressive treatment with antihypertensives.
true
magnesium sulfate is agent of choice for prevention of SEIZURES in severe preeclampsia by
50% reduction from 1.9% to 0.8%
most commonly used agent for control of severe hypertension:
IV HYDRALAZINE 5 - 10 mg every 15-20 minsmax 30 mg
IV LABETALOL 20-40mg every 10-15 mins max 220mg
Oral NIFEDIPINE 10-20mg every 30 mins for a max of 50mg
calcium channel blockers used with IV mag sulfate may lead to maternal hypotension
true
HELLP syndrome
- morbid end of preeclampsia spectrum, perinatal mortality rate of 7-20%.
- delivery should be expedited if pt is at least 34 weeks.
differential dx of HELLP
acute fatty liver of pregnancy thrombotic thrombocytopenic purpura hemolytic uremic syndrome immune throbocytopenic purpura systemic lupus erythematosus antiphospholipid antibody syndrome cholecystitis fulminant viral hepatitis acute pancreatitis
management of HELLP, platelet transfusion is indicated in pts with active bleeding or platelet count <20,000 or in advance of a c/S with platelet count less than 50,000
true
recurrence risk of HELLP
2%-19%
Pt with hx of preeclampsia
obtain baseline metabolic profile, complete blood count, baseline UA, baseline 24 hr urine for protein.
administer ___ for seizure prophylaxis
magnesium sulfate
all pts with preeclampsia <34 weeks should be given
antenatal corticosteroids for fetal lung maturity.
___ is the only intervention that possibly helpful to decrease risk of recurrent preeclampsia
aspirin
