HDP Flashcards
List five maternal and three fetal complications of the hypertensive disorders of pregnancy.
Maternal: stroke, pulmonary edema, liver failure, seizure, placental abruption, acute renal failure
Fetal: oligohydramnios, IUGR, metabolic acidosis, fetal death
Which is the better predictor of adverse pregnancy outcome: systolic or diastolic blood pressure?
Diastolic blood pressure
Define HTN & severe HTN.
HTN: sBP > 140 or dBP > 90 on at least two measurements at least fifteen minutes apart in the same arm
(If measurements are different between the two arms, use the higher number)
Severe HTN: sBP > 160 or dBP > 110 (same stipulations as above)
What is the value of repeating definitive testing for proteinuria (24 hour urine protein collection or urinary protein:creatinine) in a patient who has been confirmed to have significant proteinuria?
No value.
How is super-imposed preeclampsia diagnosed in a patient with pre-gestational hypertension?
One or more of the following after 20 weeks’ gestation:
- Resistant HTN (rise in BP or need for 3+ antihypertensives)
- New or worse proteinuria
- One or more adverse condition
- One or more severe complication
List three factors which lower the maternal threshold for preeclampsia.
- Metabolic syndrome
- Chronic infection or inflammation
- Pre-existing hypertension
- Chronic kidney disease
- DM
- High altitude
Describe the two models by which preeclampsia may arise.
Early onset/placental preeclampsia: imperfect placentation (immunological factors, interaction between decidua & trophoblast)
Late onset/maternal preeclampsia: lowered maternal threshold or excessive physiologic placentation (chronic disease, high altitude)
Both may coexist!
For each organ system, list one possible adverse condition & one possible severe complication of preeclampsia: CNS Cardio-respiratory Hematologic Renal Hepatic
CNS:
- HA, visual symptoms
- eclampsia, PRES, cortical blindness, stroke, GCS < 13
Cardio-respiratory:
- CP, dyspnea, sat < 97%
- uncontrolled HTN, pulmonary edema, need for inotropes, MI
Heme:
- elevated WBC, decreased platelets, elevated INR/PTT
- platelets < 50, need for transfusion of any blood product
Renal:
- elevated creatinine, elevated uric acid
- AKI, need for dialysis
Hepatic:
- N & V, RUQ or epigastric pain, elevated liver enzymes or bilirubin, hypoalbuminemia
- INR > 2 without DIC, hepatic hematoma or rupture
List five tests that should be performed early in pregnancy for women with pre-existing hypertension (to stratify risk & establish baseline).
Creatinine Potassium Fasting blood glucose Urinalysis EKG
What two medications may reduce the incidence of preeclampsia in low-risk women? When should they be initiated? What additional intervention may reduce risk?
Calcium 1 g/day in women w/ low dietary intake - start before 16 weeks (when most transformation of the uterine spiral arteries occurs)
Folate - start prior to conception
Exercise
True or False:
- Antihypertensive treatment reduces risk of eclampsia
- Antihypertensive treatment reduces risk of adverse fetal and neonatal outcomes
- Antihypertensive treatment reduces risk of CVA
False
False
True
Which beta blocker is not recommended in pregnancy, and why?
Atenolol - associated with IUGR, maternal hypotension, maternal bradycardia
By what gestational age should you deliver women with uncomplicated pre-gestational hypertension?
38-39 weeks
For women with any HDP, what is the target intrapartum blood pressure?
< 160/110
You need to give magnesium sulfate for seizure prophylaxis, but cannot get IV access. What is the alternate dose & route?
MgS04 10 g IM (5 in each buttock) loading dose, then 5 g IM q4h
List three possible side effects of MgS04.
Weakness Paralysis Cardiac toxicity Loss of patellar reflexes Respiratory depression
How do you treat magnesium toxicity?
Give 10 mL calcium gluconate IV (push over 3 minutes)
List three reasons to avoid NSAID use postpartum in women with HDP.
HTN is difficult to control postpartum
Oliguria or AKI (creatinine > 90)
Platelets < 50
