HPN Cx

Question 1

diagnosed with sustained elevation of BP ≥ 140/90 mm

Hg after 20 weeks of pregnancy without proteinuria. BP returns to normal baseline postpartum.

Answer 1

Gestational hypertension

Question 2

In GH, Close observation is prudent

since _______ of patients will develop preeclampsia.

Answer 2

30%

Question 3

sustained BP elevation in pregnancy after 20 weeks’ gestation in the absence of preexisting hypertension

Answer 3

Preeclampsia

Question 4

Dx of PE

Answer 4

• Sustained BP elevation of ≥140/90 mm Hg.

* Proteinuria of ≥300 mg on a 24-h urine collection or protein/creatinine ratio of ≥0.3.

Question 5

Preeclampsia is found 8 times more frequently in _____

Answer 5

primiparas

Question 6

Other RF for PE

Answer 6

Other risk factors are multiple gestation, hydatidiform mole, diabetes mellitus, age extremes, chronic hypertension,
and chronic renal disease.

Question 7

Pathophysio of PE

1. diffuse vasospasm caused by ______

Answer 7

loss of the normal pregnancy-related refractoriness to vasoactive substances such as angiotensin;

Question 8

Pathophysio of PE

2. relative or absolute changes in the following prostaglandin substances:

Answer 8

increases in the vasoconstrictor thromboxane along with decreases in the potent vasodilator prostacyclin.

Question 9

With preeclampsia without severe features the

symptoms and physical findings, if present, are generally related to excess______ and ______

Answer 9

weight gain and fluid retention.

Question 10

In PE

Evidence of hemoconcentration is shown by
1
2
3

Answer 10

elevation of hemoglobin, hematocrit, blood urea nitrogen (BUN), serum creatinine, and serum uric acid

Question 11

Evidence of ________ or ________ would move the diagnosis from preeclampsia without
severe features to preeclampsia with severe features

Answer 11

disseminated intravascular coagulation

(DIC) or liver enzyme elevation

Question 12

Mx of PE before 37 weeks AOG

Answer 12

Before 37 weeks’ gestation as long as mother and fetus are stable, mild preeclampsia is managed in the hospital or as outpatient, watching for possible progression to severe preeclampsia

Question 13

Mx of PE after 37 weeks AOG

Answer 13

Delivery. At ≥37 weeks’ gestation, delivery is indicated with dilute IV oxytocin induction
of labor and continuous infusion of IV MgSO4 to prevent eclamptic seizures

Question 14

PE with severe features:

The diagnosis is made on the basis of the finding of at least mild elevation of BP and mild proteinuria plus any one of the following:
1
2
3

Answer 14

• Sustained BP elevation of ≥160/110.
• Evidence of maternal jeopardy
• Edema may or may not be seen.

Question 15

What are the evidences of maternal jeopardy

Answer 15

This may include symptoms (headache, epigastric
pain, visual changes), thrombocytopenia (platelet count <100,000/mL), doubling of liver transaminases, pulmonary edema, serum creatinine >1.1 mg/dL, or doubling of
serum creatinine.

Question 16

RF for severe PE

Answer 16

These are the same as preeclampsia with the addition of diseases with small vessel disease such as systemic lupus and longstanding overt diabetes.

Question 17

How to give MgSO4

Answer 17

Administer IV MgSO4 to prevent convulsions. Give a 5-g loading dose, then continue maintenance infusion of 2 g/h. Continue IV MgS04 for 24 hours after delivery

Question 18

Conservative inpatient management may rarely be attempted in absence of maternal and
fetal jeopardy with gestational age 26–34 weeks if_________

Answer 18

BP can be brought <160/110 mm Hg.

Question 19

__________ is the presence of unexplained generalized seizures in a hypertensive,
proteinuric pregnant woman in the last half of pregnancy

Answer 19

Eclampsia

Question 20

Pathophysio of eclampsia

Answer 20

Pathophysiology is severe diffuse cerebral vasospasm resulting in cerebral perfusion deficits and cerebral edema

Question 21

Management of eclampsia. The first step is to protect the mother’s airway and tongue. Other measures
1
2
3

Answer 21

Administer MgSO4
Aggressive prompt delivery
Lower diastolic BP

Question 22

T or F, in eclampsia,

Attempt vaginal delivery with IV oxytocin infusion
if mother and fetus are stable

Answer 22

T

Question 23

The diagnosis of _____ is made when BP ≥140/90 mm Hg with onset before the pregnancy or before 20 weeks’ gestation

Answer 23

chronic HTN

Question 24

GP in chronic HPN

Answer 24

Favorable maternal and neonatal outcome is found when BP 140/90– 179/109 mm Hg and no evidence of end-organ damage.

Question 25

Worst Prognosis in pts with chronic HPN

Answer 25

Tenfold higher fetal loss rate if uncontrolled HTN (before conception or early in pregnancy) and chronic HTN with superimposed preeclampsia.

Question 26

This complication occurs in 25% of patients with chronic HTN. Risk factors include renal insufficiency, HTN for previous 4+ years, and HTN in a previous pregnancy.

Answer 26

Chronic HTN with Superimposed Preeclampsia

Question 27

Drug of choice for Chronic HTN with Superimposed Preeclampsia

Answer 27

The drug of choice is methyl-dopa because of extensive experience and documented fetal safety

Question 28

b-blocking agents are associated with ______

Answer 28

intrauterine growth retardation (IUGR)

Question 29

Angiotensin-converting enzyme inhibitors are contraindicated in pregnancy, as they have been associated with _____

Answer 29

fetal hypocalvaria, renal failure, oligohydramnios, and death.

Question 30

Diuretics should not be initiated during pregnancy

owing to possible _______

Answer 30

adverse fetal effects of associated plasma volume reduction

Question 31

Chronic HTN with Superimposed Preeclampsia

Conservative outpatient management

Answer 31

Stop drug therapy
Serial sonograms
Serial BP and urine protein
Induce labor at 39 weeks

Question 32

HELLP syndrome occurs in 5–10% of preeclamptic patients and is characterized by

Answer 32

hemolysis (H), elevated liver enzymes (EL), and low platelets (LP).

Question 33

HELLP syndrome occurs twice as often in _______

Answer 33

multigravidas as primigravidas.

Question 34

HELLP syndrome, Use of maternal________

may enhance postpartum normalization of liver enzymes and platelet count

Answer 34

corticosteroids