Class 2: blood pressure issues

Question 1

what are gestational conditions

Answer 1

disorders that did not exist before pregnancy

Question 2

what is pre eclampsia

Answer 2

basically vasospasm in spiral arteries. They get fibrous and constricted (they should be dilated)
this results in less blood flow getting to fetus
fetus then produces pro-inflammatory proteins that damage endothelial cells and lead to vasoconstriction and salt retention (which increases BP)

Question 3

what is one test that tests for pre-eclampsia

Answer 3

urine test for protein uria

Question 4

what is non-severe HTN in pregnancy

Answer 4

> 140/>90

Question 5

how should you measurer BP in pregnant person

Answer 5

taken at least 15 mins apart, after 5 mins of rest
if both values are high take the higher one

Question 6

what is severe HTN in pregnancy

Answer 6

> 160
110

Question 7

how soon should you treat a pregnant person with severe HTN

Answer 7

treat as an emergency, should be treated within 30-60 mins (if you were to prioritise it would be this first unless someone was literally bleeding out)

Question 8

what is superimposed pre-eclampsia

Answer 8

someone who develops pre eclampsia who already has HTN (instead of the other way around where the constricted spiral arteries lead to HTN)

Question 9

what are the main risk factors for pre eclampsia

Answer 9

• been a long time since last period (or no period at all)
• any fam history or personal history with pre eclamsea or weird birth
• heavy: DM, increased BMI, sleep apnea
• kidney issues or clotting issues or chronic HTN

Question 10

draw mind map of how pre eclampsia happens

Question 11

what value of proteinuria indicates pre eclampsia in a pregnant person

Answer 11

0.03g/L or more in at least two random urine specimens
collected 6 hours apart
no evidence of UTI

Question 12

what is the cure to pre-eclampsia

Answer 12

getting the placenta out

Question 13

what is eclampsia

Answer 13

seizures in women diagnosed with pre-eclampsia with no other history that would explain the seizures

Question 14

what are the specific symptoms of eclampsia

Answer 14

headache
severe epigastric pain
hyperreflexia

Question 15

what are the main symptoms of HELLP syndrome

Answer 15

(remember its hemolysis, elevated liver enzymes and Low platelets, comes from pre-eclampsea)
fatigue
RUQ pain
Dizzy
lots of Nausea and vomiting

Question 16

what are the main things we do to manage HTN in pregnancy

Answer 16

blood pressure control
lifestyle changes (exercise, diet)
monitor for pre-eclamsea
seizure prophylaxis
planning for timing of delivery
postpartum surveillance
get fetus as big as possible before inducing labour

Question 17

what is the goal of Diastolic BP in pregnancy and why

Answer 17

above 85 because we want to maintain blood flow to the fetus

Question 18

what are the two antihypertensives to avoid with pregnancy

Answer 18

ACE inhibitors and ARB (anything with RAAS rlly because its a slippery slope)(

Question 19

what are the four antihypertensives usually given to preggos

Answer 19

-labetolol
hydralazine
nifedipine
methyldopa

Question 20

what medication is ordered for seizure prevention

Answer 20

magnesium sulfate

Question 21

what are some things you should do to manage Hypertensive pregnancy patients in the hospital

Answer 21

BP control, meds, seizure precautions, continuous fetal monitoring, prepare for birth

Question 22

what does magnesium sulfate do for pre eclampsia and HTN in pregnancy

Answer 22

prevents seizure. should be given in all cases of severe or sustained HTN (over 160/110)

Question 23

what is the usual dosing for magnesium sulfate

Answer 23

4g IV loading dose over 13 mins, piggy back
then 1g/hr continuous infusion maintenance IV

Question 24

what are some adverse effects we need to watch for in a preggo getting magnesium sulfate

Answer 24

watch for low HR, low RR< low kidney function, low reflexes because it basically stops all high frequency activity in the body

Question 25

can you leave ppl on magnesium sulfate alone?

Answer 25

no

Question 26

what is the antedote for magnesium toxicity

Answer 26

calcium gluconate

Question 27

how often should you monitor vitals with someone on magnesium sulfate

Answer 27

every 30 mins

Question 28

how often should you monitor urine output with someone on magnesium sulphate

Answer 28

every hour

Question 29

how often should you monitor reflexes with someone on magnesium sulfate

Answer 29

upon completion of loading dose and every hour while on therapy

Question 30

on magnesium gluconate, when should you apply continuous fetal monitoring

Answer 30

when theyre over 26 weeks gestation

Question 31

signs of magnesium toxicity

Question 32

what are some intervetions after a seizure

Answer 32

suction
O2 at 10L
insert IV and run IV fluid
monitor FHR
prepare for birth (siezure can trigger labour)
risk for placental abruption

Question 33

when should labour happen for someone with chronic HTN

Answer 33

should be planned around 38-39 weeks to minimize risk

Question 34

when should labour happen for gestational HTN

Answer 34

37 weeks to reduce progression into preeclampsiia

Question 35

when should labour happen for someone with pre-eclampsia

Answer 35

should happen 34-37 weeks, but ideally as soon as possible after its been diagnosed

Question 36

why would magnesium sulfate increase risk of haemorrhage

Answer 36

because they stop contraction of the uterus which is needed to stop hemmorhage