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OB/GYN > HTN and pg'y > Flashcards

HTN and pg'y Flashcards

1
Q

what is AFLP?

A

acute fatty liver of pg’y

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2
Q

what is preeclampsia

A

nondependent edema + HTN + proteinuria in a pg pt.

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3
Q

pathophys of preeclampsia

A

generalized arteriolar cstr’n 2/2 circ’ing Ag-Ig complexes

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4
Q

fetal complicatinos of preeclampsia

A

related to prematurity due to early delivery

acute or chronic uteroplacental insuff’y, IUGR, oligohydramnios

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5
Q

maternal complications of preeclampsia

A 
severe HA not relieved by tylenol
vision changes/scotomata
stroke
renal failure
pulmonary edema
liver edema
subcapsular liver hematoma
thrombocytopenia
DIC
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6
Q

what is “severe preeclampsia”

A

elevated BP and any of the complications listed above

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7
Q

what is HELLP syndrome?

A

a subcategory of preeclampsia with hemolysis, elevated LFTs, low plts

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8
Q

when is preeclampsia most often seen

A

in 3rd tri, near term

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9
Q

what should you suspect if you see HTN in early second tri (14-20 weeks)?

A

hydatidiform mole or previously undx’d chronic HTN

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10
Q

how can HELLP present in rare cases?

A

RUQ pain without a previous dx of preeclampsia

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11
Q

RFs for preeclampsia

A 
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
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12
Q

how to dx GH or pg’y-induced HTN:

A

2 bps of > 140/90, taken at least 4 hours apart w/pt seated

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13
Q

mgt of GH?

A

do a 24-hr urine protein collection to r/o preeclampsia. If < 300mg in 24h, its r/o.

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14
Q

how to make dx of mild preeclampsia:

A

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

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15
Q

why is spot urine protein:cr useful?

A

b/c excretion of creatinine is constant, so it can estimate protein excretion in 24h.

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16
Q

what is eclampsia?

A

preeclampsia with seizures

17
Q

how to make dx of severe preeclampsia

A

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

18
Q

why do pts w/HELLP dvp epigastric pain?

A

distension of liver capsule

19
Q

how is AFLP diff from HELLP?

A

signs of liver failure - elevated ammonia, blood G < 50, low fibrinogen & antithrombin III

20
Q

tx of mild preeclampsia

A

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

21
Q

tx of severe preeclampsia

A

MgSO4
hydralazine (for bp control)
if not to term yet, expectant management to gain time w/betamethasone

deliver immediately if unstable

22
Q

will preeclampsia resolve after delivery?

A

not always. Can persist for weeks. If BP is still high, give labetalol or nifedipine

23
Q

tx for lingering thrombocytopenia in a pt w/HELLP?

A

corticosteroids

24
Q

women w/previous preeclampsia and chronic HTN can do what to decrease risk of preeclampsia in subsequent pg’ies?

A

low-dose aspirin prior to and during pg’y

25
Q

when can preeclamptic women become eclamptic?

A

before labor, during, or within 48h after, occasionally several weeks after

26
Q

tx of eclampsia

A

hydralazine

MgSO4 continued till 4h post partum

27
Q

what is a therapeutic & safe MgSO4 level?

A

4.8 to 8.4

28
Q

tx for MgSO4 overdose?

A

10mL CaCl or CaGluconate to stabilize heart

29
Q

when should delivery be attempted in an eclamptic pt?

A

after mom is stabilized. Only do c/s if obstetric indication.

30
Q

dx of chronic HTN?

A

HTN present before conception, before 20w gestation, or persisting +6w post-partum

31
Q

mgt of chronic HTN in pg’y?

A

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

32
Q

how to find superimposed preeclampsia in a pt w/chronic HTN?

A

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

33
Q

how often do chronic HTN’ves dvp preeclampsia?

A

1/3

OB/GYN (29 decks)

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