HTN and pg'y Flashcards
what is AFLP?
acute fatty liver of pg’y
what is preeclampsia
nondependent edema + HTN + proteinuria in a pg pt.
pathophys of preeclampsia
generalized arteriolar cstr’n 2/2 circ’ing Ag-Ig complexes
fetal complicatinos of preeclampsia
related to prematurity due to early delivery
acute or chronic uteroplacental insuff’y, IUGR, oligohydramnios
maternal complications of preeclampsia
severe HA not relieved by tylenol vision changes/scotomata stroke renal failure pulmonary edema liver edema subcapsular liver hematoma thrombocytopenia DIC
what is “severe preeclampsia”
elevated BP and any of the complications listed above
what is HELLP syndrome?
a subcategory of preeclampsia with hemolysis, elevated LFTs, low plts
when is preeclampsia most often seen
in 3rd tri, near term
what should you suspect if you see HTN in early second tri (14-20 weeks)?
hydatidiform mole or previously undx’d chronic HTN
how can HELLP present in rare cases?
RUQ pain without a previous dx of preeclampsia
RFs for preeclampsia
disease-related: chronic HTN chronic renal dis collagen vasc dis (SLE) pregestational DM AfAm young or advanced maternal age Immunologic-related: nulliparity prior hx of preeclampsia maternal FHx of preeclampsia mother in law having preeclampsia parental ethnic discordance
how to dx GH or pg’y-induced HTN:
2 bps of > 140/90, taken at least 4 hours apart w/pt seated
mgt of GH?
do a 24-hr urine protein collection to r/o preeclampsia. If < 300mg in 24h, its r/o.
how to make dx of mild preeclampsia:
3rd-tri BP > 140/90 on 2 occasions 6 hrs apart + > 300mg proteinuria in 24 hrs. Nondependent edema is not necessary for dx. Can also use a urine prot:creatinine ratio of > 0.3
why is spot urine protein:cr useful?
b/c excretion of creatinine is constant, so it can estimate protein excretion in 24h.
what is eclampsia?
preeclampsia with seizures
how to make dx of severe preeclampsia
BP > 160/110 on 2 occasions at least 6h apart + proteinuria > 500mg in 24h
or,
mild preeclampsia + vision changes or HA, epigastric or RUQ pain, elevated LFTs, oliguria, pulmonary edema, plts < 100,000
why do pts w/HELLP dvp epigastric pain?
distension of liver capsule
how is AFLP diff from HELLP?
signs of liver failure - elevated ammonia, blood G < 50, low fibrinogen & antithrombin III
tx of mild preeclampsia
if at term of if pg’y unstable or if evidence of fetal lung maturity, induce labor.
if not, start MgSO4 for seizure ppx during labor, continue for 24h after delivery
tx of severe preeclampsia
MgSO4
hydralazine (for bp control)
if not to term yet, expectant management to gain time w/betamethasone
deliver immediately if unstable
will preeclampsia resolve after delivery?
not always. Can persist for weeks. If BP is still high, give labetalol or nifedipine
tx for lingering thrombocytopenia in a pt w/HELLP?
corticosteroids
women w/previous preeclampsia and chronic HTN can do what to decrease risk of preeclampsia in subsequent pg’ies?
low-dose aspirin prior to and during pg’y
when can preeclamptic women become eclamptic?
before labor, during, or within 48h after, occasionally several weeks after
tx of eclampsia
hydralazine
MgSO4 continued till 4h post partum
what is a therapeutic & safe MgSO4 level?
4.8 to 8.4
tx for MgSO4 overdose?
10mL CaCl or CaGluconate to stabilize heart
when should delivery be attempted in an eclamptic pt?
after mom is stabilized. Only do c/s if obstetric indication.
dx of chronic HTN?
HTN present before conception, before 20w gestation, or persisting +6w post-partum
mgt of chronic HTN in pg’y?
leave it if 140/90 or less
if higher, nifedipine or labetalol
obtain baseline ECG and 24-h urine collection for CrCl and protein
can try low-dose aspirin
how to find superimposed preeclampsia in a pt w/chronic HTN?
increase in SBP of 30mmHg or more, or 15mmHg or more in DBP
or, elevated 24-hr urine prot
or, elevated uric acid in pts w/baseline renal dis
how often do chronic HTN’ves dvp preeclampsia?
1/3
