HTN

Question 1

chronic HTN

Answer 1

• ≥140/90 (mild)
• ≥180/110 (severe)

BEFORE 20 weeks GA OR prior dx that predates pregnancy

Question 2

What are chronic HTN pts at risk of developing?

Answer 2

superimposed pre-eclampsia

Question 3

T or F: mild chronic HTN should be treated pharmacologically in pregnancy

Answer 3

false

Question 4

What HTN pharm tx are preferred in pregnancy?

Answer 4

• beta blockers

- Ca channel blockers

Question 5

What HTN pharm tx are contraindicated in pregnancy?

Answer 5

• ACE inhibitors

- ARBs

Question 6

What is goal BP while on meds?

Answer 6

120-160/80-105

Question 7

When should chronic HTN pts deliver?

Answer 7

around EDD

Question 8

gestational HTN

Answer 8

• ≥140/90
• MAP ≥ 105mmHg

AFTER 20 wks GA, @ least twice, 4-6h apart in ABSENCE of proteinuria or systemic findings

Question 9

When does BP return to baseline in GHTN?

Answer 9

12 wks PP

Question 10

pre-eclampsia w/out severe features

Answer 10

• ≥140/90

AFTER 20 wks GA, @ least twice, 4-6h apart WITH proteinuria

Question 11

pre-eclampsia w/ severe features

Answer 11

• ≥160/110

WITH proteinuria
OR
w/out proteinuria AND s/s end-organ damage (e.g. thrombocytopenia, impaired LFT, renal insufficiency)

Question 12

proteinuria

Answer 12

- ≥300mg proteinuria/24h 
OR 
- ≥1+ on dipstick on 2 specimens 6h apart 
OR 
- protein/creatinine ratio of 0.3

Question 13

How can pre-eclampsia be prevented?

Answer 13

daily, low-dose (60-80mg) ASA beginning late 1st tri (12-16 wks) until 37 wks

Question 14

eclampsia

Answer 14

new onset seizures w/ HTN and/or preteinuria

Question 15

HELLP syndrome

Answer 15

H emolytic anemia
E levated...
L iver enzymes (inc ALT/AST)
L ow...
P latelets

Question 16

When should pts w/ pre-eclampsia deliver?

Answer 16

@ 37.0

Question 17

When should pts w/ HELLP deliver?

Answer 17

@ 37.0

Question 18

What are the 3 theories of pathogenesis for HTN in pregnancy?

Answer 18

1) systemic inflammatory response –> vascular damage (thromboxane = constrictor > prostacyclin = dilator)
2) abnormal placentation: hypertrophy of muscles surrounding spiral arteries –> constriction –> dec blood flow
3) immune-mediated: rejection of pregnancy; new paternity = risk

Question 19

What are maternal risks of HTN?

Answer 19

• seizure
• cerebral hemorrhage
• thrombocytopenia
• disseminated intravascular coagulation (DIC)
• renal failure
• liver failure

Question 20

What are risks of HTN to fetus?

Answer 20

• oligohydramnios
• growth restriction
• still birth
• placental abruption
• placental infarction
• intrapartum fetal distress

Question 21

What are obstetric risks of HTN?

Answer 21

• uteroplacental insufficiency
• premature delivery
• placental abruption
• C/S

Question 22

When should pts w/ severe pre-eclampsia deliver?

Answer 22

@ 34 wks

Question 23

What s/s should HTN pts be asked about at every visit?

Answer 23

• headaches
• RUQ pain
• vision change
• fetal movement

Question 24

How should pts w/ GHTN or pre-eclampsia w/out severe features be managed?

Answer 24

expectantly until 37 wks

• NST/AFI 2x/wk
• BP check 1-2x/wk
• lab eval q1 wk
• serial growth U/S qq3-4wks

*no anti-HTN meds if BP<160/110

Question 25

How should pts w/ pre-eclampsia w/ severe features be managed?

Answer 25

expectant management until 34 wks if no evidence of:

1) HELLP
2) eclampsia
3) pulmonary edema
4) stroke
5) abruption
6) DIC
7) labor or PPROM
8) oligohydramnios
9) new onset or inc renal dysfunction
10) non-reassuring fetal status

Question 26

When should mag sulfate be used?

Answer 26

in SEVERE cases of pre-eclampsia to prevent seizure

Question 27

When should mag sulfate be avoided?

Answer 27

• in mild disease

- in pts w/ pulmonary edema