Chapter 27 Flashcards
Why are hypertensive disorders a major cause of perinatal morbidity and mortality ?
hypertension can cause Uteroplacental insufficiency and Premature birth
How many maternal deaths worldwide are due to preeclampsia and eclampsia?
10-15%
how many maternal deaths are caused by preeclampsia each year?
50,000
What are possible compilations related to hypertensive disorders that increase morbidity ?
Renal failure
Coagulopathy
Cardiac or liver failure
Placental abruption
Seizures
Stroke
Define gestational hypertension
Onset of hypertension without proteinuria or other systemic findings diagnostic for preeclampsia after week 20 of pregnancy
Systolic BP >140, diastolic BP >90
Define preeclampsia
Pregnancy-specific condition in which hypertension and proteinuria develop after 20 weeks of gestation in a previously normotensive woman
What is preeclampsia in the absence of proteinuria ?
Hypertension along with the following:
Thrombocytopenia
Impaired liver function
New development of renal insufficiency
Pulmonary edema
New-onset cerebral or visual disturbances
What is the general rule for hypertension
BP 140/90 or 30 increased in SPB and 15 increase in DBP
When is weigh gain concerning with hypertension?
weight gain of 2kg in 1 week
How is protein in urine tested?
done via dipstick measure test
Proteinuria is a concentration of 1+ or greater via dipstick measure
If urine dipstick is abnormal , will send to lab for UA
If proteinuria is 3+ on dipstick = great concern
what is done to check for protein if no other symptoms are shown?
24 hr urines
Define eclampsia
Onset of seizure activity or coma in a woman with preeclampsia
No history of preexisting pathology
Women can develop eclampsia in the immediate postpartum period
Define chronic hypertension
Hypertension present before pregnancy or diagnosed before week 20 of gestation
can have chronic HTN that last longer than 6 wks PP
Define Chronic hypertension with superimposed preeclampsia
Women with chronic hypertension may acquire preeclampsia or eclampsia
Can be difficult to diagnose
Common risk factors for preeclampsia
Primigravidity in woman <19 or >40 years of age
First pregnancy with a new partner
History of preeclampsia
Pregnancy-onset snoring
what is the etiology of preeclampsia
the cause is unknown , condition is unique to pregnancy , delivery baby and placenta makes it go away
What is the pathophysiology of preeclampsia ?
Spiral arteries in the uterus normally become larger and thicker to handle increased blood volume.
the arteries do not get larger/thicker in preeclampsia or partially develops causing decreased placental perfusion and hypoxia
symptoms of placental abruption
:Increased contractions, rigid, Dark red vaginal, bleeding , painful,
what other issues can preeclampsia cause?
Placental ischemia → endothelial cell dysfunction
Generalized vasospasm → poor tissue perfusion in all organ systems
Increased peripheral resistance and blood pressure
Increased risk of Abruptio Placentae (detachment)
Increased endothelial cell permeability
Reduced kidney perfusion
Plasma colloid osmotic pressure decreases.
Decreased liver perfusion
Neurologic complications
how does preeclampsia affect the liver
liver becomes inflamed and elevated LFTs
How do you check for clonus ?
move foot around then push up and it will bounce
positive clonus is bad
what is a normal reflex
2+
what is HELLP syndrome
severe preeclampsia that involves liver dysfunction
H - hemolysis
EL - Elevated liver enzymes
LP - Low Platelets
What liver labs do you look at to check for HELLP syndrome ?
AST and ALT
ALP is always elevated in pregnancy
