HPN Cx Flashcards
diagnosed with sustained elevation of BP ≥ 140/90 mm
Hg after 20 weeks of pregnancy without proteinuria. BP returns to normal baseline postpartum.
Gestational hypertension
In GH, Close observation is prudent
since _______ of patients will develop preeclampsia.
30%
sustained BP elevation in pregnancy after 20 weeks’ gestation in the absence of preexisting hypertension
Preeclampsia
Dx of PE
- 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.
Preeclampsia is found 8 times more frequently in _____
primiparas
Other RF for PE
Other risk factors are multiple gestation, hydatidiform mole, diabetes mellitus, age extremes, chronic hypertension,
and chronic renal disease.
Pathophysio of PE
- diffuse vasospasm caused by ______
loss of the normal pregnancy-related refractoriness to vasoactive substances such as angiotensin;
Pathophysio of PE
- relative or absolute changes in the following prostaglandin substances:
increases in the vasoconstrictor thromboxane along with decreases in the potent vasodilator prostacyclin.
With preeclampsia without severe features the
symptoms and physical findings, if present, are generally related to excess______ and ______
weight gain and fluid retention.
In PE
Evidence of hemoconcentration is shown by
1
2
3
elevation of hemoglobin, hematocrit, blood urea nitrogen (BUN), serum creatinine, and serum uric acid
Evidence of ________ or ________ would move the diagnosis from preeclampsia without
severe features to preeclampsia with severe features
disseminated intravascular coagulation
(DIC) or liver enzyme elevation
Mx of PE before 37 weeks AOG
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
Mx of PE after 37 weeks AOG
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
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
- Sustained BP elevation of ≥160/110.
- Evidence of maternal jeopardy
- Edema may or may not be seen.
What are the evidences of maternal jeopardy
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.
RF for severe PE
These are the same as preeclampsia with the addition of diseases with small vessel disease such as systemic lupus and longstanding overt diabetes.
How to give MgSO4
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
Conservative inpatient management may rarely be attempted in absence of maternal and
fetal jeopardy with gestational age 26–34 weeks if_________
BP can be brought <160/110 mm Hg.
__________ is the presence of unexplained generalized seizures in a hypertensive,
proteinuric pregnant woman in the last half of pregnancy
Eclampsia
Pathophysio of eclampsia
Pathophysiology is severe diffuse cerebral vasospasm resulting in cerebral perfusion deficits and cerebral edema
Management of eclampsia. The first step is to protect the mother’s airway and tongue. Other measures
1
2
3
Administer MgSO4
Aggressive prompt delivery
Lower diastolic BP
T or F, in eclampsia,
Attempt vaginal delivery with IV oxytocin infusion
if mother and fetus are stable
T
The diagnosis of _____ is made when BP ≥140/90 mm Hg with onset before the pregnancy or before 20 weeks’ gestation
chronic HTN
GP in chronic HPN
Favorable maternal and neonatal outcome is found when BP 140/90– 179/109 mm Hg and no evidence of end-organ damage.
