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ENDOREPRO II Exam I > [CLMD] Hypertensive Disorders in Pregnancy [Wootton] > Flashcards

[CLMD] Hypertensive Disorders in Pregnancy [Wootton] Flashcards

1
Q

What are the different classifications of Hypertension in Pregnancy?

A

Chronic HTN

Gestational HTN

Preeclampsia

Eclampsia

Superimposed Preeclampsia/Eclampsia

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2
Q

What is Chronic HTN?

A

HTN that is present before or recognized during the first half of the pregnancy

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3
Q

When is Gestational HTN diagnosed?

A

Recognized after 20 weeks gestation

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4
Q

How would you diagnose Preeclampsia?

A

Occurs after 20 weeks gestation and coexsists with proteinuria

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5
Q

How would you diagnosed Eclampsia?

A

patient usually has Pre-Eclampsia, than onset of Seizure activity

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6
Q

When you would diagnose Superimposed Preeclampsia/Eclampsia?

A

When you have symptoms of Eclampsia/Preeclampsia TRANSPOSED onto Chronic HTN

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7
Q

What are the guidelines of Blood Pressure categories for Non-Pregnant Humans?

A

Normal – 120/80

Elevated – 120-129/ <80

STAGE 1 – 130-139/80-89

STAGE 2 – >140/>90

HTN Crisis – >180/>120

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8
Q

What are some causes of Chronic HTN in a pregnant women?

A

Idiopathic (most commonly)

Vascular Disorders – aortic coarctation

Endocrine Disorders – diabetes/hyperthyroid

Renal Disorders – chronic renal failure

Connective Tissue Disorders – SLE

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9
Q

How would you assess for maternal end-organ damage when having a potential Chronic HTN patient?

A

CBC, CMP

Glucose

EKG, Echo

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10
Q

What are the two forms of antihypertensive therapy approved for management of severe chronic HTN in pregnancy?

A

Labetalol

Nifedipine

(these are our first line agents)

Methyldopa, as well – but less so used

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11
Q

What antihypertensive drugs are never used in pregnancy?

A

ACE Inhibitiors

ARBS

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12
Q

What do we call HTN without any features of Preecampsia, which occurs either after 20 weeks or withing 48-72 hours after delivery?

A

Gestational HTN

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13
Q

What are the three signs that are used to Diagnose Preeclampsia?

A

HTN

Proteinuria

Edema

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14
Q

What are the main symptoms we see with Pre-eclampsia?

A

Scotoma – vision disturbances

Blurred Vision

Epigastric/ RUQ pain

Headache (that doesnt improve with ibuprofen)

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15
Q

How does Preeclampsia affect the Brain?

Heart?

Lungs?

A

Brain – causes Cerebral Edema, fibrinoid necrosis, thrombosis

Heart – causes third spaces –> reducing circulating blood vol

Lungs – causes Pulmonary Edema (Leaking vessels)

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16
Q

How Does Preeclampsia affect the Liver?

Kidneys?

Eyes?

A

Liver – causes a Subcapsular Hematoma –> Liver Rupture

Kidney – Swelling of endothelial cells –> narrowing capillary lumen

Eyes – Retinal Edema/Vasospasm

17
Q

What is the etiology of Preeclampsia?

A

UNKNOWN!

18
Q

What are the Risk Factors of Pre-Eclampsia?

A

Age ( <20, >35)

First Pregnancy

Multiple Gestations (twins)

Hydatidiform Mole

Diabetes

High BMI pre-pregnancy

Chronic HTN

Renal Dz

SLE

Antiphospholipid Syndrome

Prior History of Preeclampsia

Obstructive Sleep Apnea

19
Q

How do you characterize Mild Preeclampsia without severe features?

A

BP <140/90 (less than 160/110)

Proteinuria >300mg over 24 hour urine collection (but less than 5 grams)

ASYMPTOMATIC

20
Q

How do you characterize Severe Preeclampsia with Severe Features?

A

BP >160/>110 (must be 2 occasions)

Proteinuria >5 grams per 24 hour

Liver Enzymes – 2x the upper limit / epigastric pain refractory to tx

Pulmonary Edema

Thrombocytopenia

Cerebral/Visual Disturbances

SYMPTOMATIC

21
Q

What would you find on examination of a person with Preeclampsia?

A

Brisk Reflexes

Clonus

Edema

22
Q

How do you cure Preeclampsia?

A

Delivery of the Baby

23
Q

If the mother has Preeclampsia without severe features (mild), and the baby is below 37 weeks what do you do?

Between 37-40 weeks?

A

Below 37 – monitor –> possibly hospitalize –> BPP/NST testing Antepartum

Between 37-40 – INDUCE if favorable cervix

if unfavorable: use cervical ripening agent to begin induction

24
Q

If you have a preeclampsia with severe features patient and she is having seizures – what can you give her?

A

Magnesium Sulfate (4 gm bolus)

(2 gm/hr for maintance)

25
Q

What is eclampsia?

A

The development of Seizures ontop of pre-eclampsia

(Most seizures last 1-2 minutes and occur within 24 hours of delivery)

PROTECT AIRWAY FIRST!!!

Mg Sulfate to treat

Lorazepam if persistent

26
Q

What is HELLP Syndrome?

A

Hemolysis

Elevated Liver enzymes

Low Platelets

** A cause for immediate delivery **

27
Q

What are the Maternal Risks of HTN?

A

MI

Death

CVA

Pulmonary Edema

Renal Failure

Preeclampsia

Gestational Diabetes

C-Section

28
Q

What are the Fetal Complications of HTN?

A

Fetal Growth Restriction

Preterm Birth

Placental Abruption

Still Birth

Neonatal Death

Congenital Anomalies

ENDOREPRO II Exam I (26 decks)

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