[CLMD] Hypertensive Disorders in Pregnancy [Wootton] Flashcards
What are the different classifications of Hypertension in Pregnancy?
Chronic HTN
Gestational HTN
Preeclampsia
Eclampsia
Superimposed Preeclampsia/Eclampsia
What is Chronic HTN?
HTN that is present before or recognized during the first half of the pregnancy
When is Gestational HTN diagnosed?
Recognized after 20 weeks gestation
How would you diagnose Preeclampsia?
Occurs after 20 weeks gestation and coexsists with proteinuria
How would you diagnosed Eclampsia?
patient usually has Pre-Eclampsia, than onset of Seizure activity
When you would diagnose Superimposed Preeclampsia/Eclampsia?
When you have symptoms of Eclampsia/Preeclampsia TRANSPOSED onto Chronic HTN
What are the guidelines of Blood Pressure categories for Non-Pregnant Humans?
Normal – 120/80
Elevated – 120-129/ <80
STAGE 1 – 130-139/80-89
STAGE 2 – >140/>90
HTN Crisis – >180/>120
What are some causes of Chronic HTN in a pregnant women?
Idiopathic (most commonly)
Vascular Disorders – aortic coarctation
Endocrine Disorders – diabetes/hyperthyroid
Renal Disorders – chronic renal failure
Connective Tissue Disorders – SLE
How would you assess for maternal end-organ damage when having a potential Chronic HTN patient?
CBC, CMP
Glucose
EKG, Echo
What are the two forms of antihypertensive therapy approved for management of severe chronic HTN in pregnancy?
Labetalol
Nifedipine
(these are our first line agents)
Methyldopa, as well – but less so used
What antihypertensive drugs are never used in pregnancy?
ACE Inhibitiors
ARBS
What do we call HTN without any features of Preecampsia, which occurs either after 20 weeks or withing 48-72 hours after delivery?
Gestational HTN
What are the three signs that are used to Diagnose Preeclampsia?
HTN
Proteinuria
Edema
What are the main symptoms we see with Pre-eclampsia?
Scotoma – vision disturbances
Blurred Vision
Epigastric/ RUQ pain
Headache (that doesnt improve with ibuprofen)
How does Preeclampsia affect the Brain?
Heart?
Lungs?
Brain – causes Cerebral Edema, fibrinoid necrosis, thrombosis
Heart – causes third spaces –> reducing circulating blood vol
Lungs – causes Pulmonary Edema (Leaking vessels)
How Does Preeclampsia affect the Liver?
Kidneys?
Eyes?
Liver – causes a Subcapsular Hematoma –> Liver Rupture
Kidney – Swelling of endothelial cells –> narrowing capillary lumen
Eyes – Retinal Edema/Vasospasm
What is the etiology of Preeclampsia?
UNKNOWN!
What are the Risk Factors of Pre-Eclampsia?
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
How do you characterize Mild Preeclampsia without severe features?
BP <140/90 (less than 160/110)
Proteinuria >300mg over 24 hour urine collection (but less than 5 grams)
ASYMPTOMATIC
How do you characterize Severe Preeclampsia with Severe Features?
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
What would you find on examination of a person with Preeclampsia?
Brisk Reflexes
Clonus
Edema
How do you cure Preeclampsia?
Delivery of the Baby
If the mother has Preeclampsia without severe features (mild), and the baby is below 37 weeks what do you do?
Between 37-40 weeks?
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
If you have a preeclampsia with severe features patient and she is having seizures – what can you give her?
Magnesium Sulfate (4 gm bolus)
(2 gm/hr for maintance)
What is eclampsia?
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
What is HELLP Syndrome?
Hemolysis
Elevated Liver enzymes
Low Platelets
** A cause for immediate delivery **
What are the Maternal Risks of HTN?
MI
Death
CVA
Pulmonary Edema
Renal Failure
Preeclampsia
Gestational Diabetes
C-Section
What are the Fetal Complications of HTN?
Fetal Growth Restriction
Preterm Birth
Placental Abruption
Still Birth
Neonatal Death
Congenital Anomalies
