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
