Clinical Applications of Pregnancy II - Westra Flashcards
What are the hypertension complications associated with pregnancy?
Chronic Hypertension Gestational Hypertension Preeclampsia Eclampsia HELLP
What medications do you NOT want to use to treat hypertension in pregnancy?
DO NOT USE ACE-inhibitors
associated with oligohydramnios and neonatal renal failure
What is chronic hypertension in pregnancy? Tx?
BP 140/90 mm Hg before pregnancy or at
What is gestational HTN?
Hypertension without proteinuria at
What is preeclampsia?
Systolic BP >140/90 mm Hg occurring after 20 weeks of gestation in a woman whose BP has previously been normal
Proteinuria, with excretion of 300 mg or more of protein in a 24-hour urine specimen
Non-dependent edema is usually present but not a criterion
What are the risk factors for preeclampsia?
Preeclampsia in previous pregnancy
Chronic hypertension
Sudden weight gain
Low dietary calcium
What two things may help reduce the risk of preeclampsia?
Calcium supplementation if low dietary calcium (less than 700 mg)
Low-dose aspirin from 12-36 weeks if hx of preeclampsia, chronic hypertension, diabetes, autoimmune disease, renal disease or current gestational hypertension.
What are the complications of preeclampsia?
Eclampsia Placenta abruption Coagulopahties Renal Faulire Hepatic Subcapsular Hematoma Hepatic Rupture Uteroplacental insufficiency
What is the treatment for preeclampsia?
Delivery is the definitive treatment dependent on the gestational age
BP: Hydralazine or Labetolol
Magnesium sulfate to prevent seizures
What are the symptoms/criteria for Severe Preeclampsia?
Systolic BP >160 mm Hg/Diastolic BP >110 mm Hg Proteinuria: >5 g in 24 hours Oliguria Pulmonary edema or cyanosis Impairment of liver function Visual or cerebral disturbances Pain in the epigastric area or right upper quadrant Decreased platelet count Intrauterine growth restriction
What is Eclampsia? Tx?
Preeclampsia with new-onset grand mal seizures
Magnesium sulfate: anticonvulsant
Rx excreted by the kidneys so monitor for urine output, respiratory depression, dyspnea (side effect of MgSO4 pulmonary edema) and hyporeflexia (loss of deep tendon reflexes)
How do you assess fetal well being in the management of complications of pregnancy?
Fetal Monitoring
Obtain Non-stress testing twice weekly
Amniocentesis/Measure amniotic fluid index once or twice weekly
Biophysical profile: fluid, fetal tone, activity, breathing, etc. may be done weekly in place of one of the twice-weekly nonstress tests and amniotic fluid index
Perform ultrasonography to assess fetal growth (every three to four weeks)
Fetal Movement: Amount of time for 10 movements (less than 2 hours reassuring)
Oxytocin stress testing: Completed when a nonstress test is nonreassuring, give IV => induce contractions and assess FHT with each contraction
What is the treatment for depression during pregnancy and postpartum depression?
SSRIs: most common
Alternatives: Tricyclic Antidepressants, Bupropion/Wellbutrin
Psychotherapy (preferably cognitive-behavioral therapy or interpersonal psychotherapy) is recommended for treatment of mild-to-moderate depression during pregnancy.
What is the “Bishop’s Score for Induction”?
Position: cervix will induce better if it is anterior
Consistency: softer is better
Effacement: higher the better
Dilation
Fetal Station
***In order to have a successful induction, need to have high score!
