HTN and Preeclampsia Flashcards
this hormone cuases dilation of the BV due to relaxing of the BV walls
elastin
What is considered HTN?
SBP > 140 and/or DBP >90
2 times 4 hours apart
4 categories of HTN
chronic
gestational
preeclampsia/eclampsia/HELLP
preeclampsia + CHTN
What is HELLP?
HTN, elevated LFT, low platelets
“preexisting HTN”
chronic HTN
HTN presents before the 20th week of pregnancy or persists longer than 12 weeks postpartum
chronic HTN
Prenatal care for chronic HTN
EKG, UA, urine culture, sCr, glucose, electrolytes, 24 hr urine, CMP, tests for renal disease (trying to r/o DM),
1 cause of infant and maternal mortality
hemolysis
what should mom with chronic HTN take during pregnancy?
low dose Aspirin (81-150 mg)
Treatment for uncomplicated mild essential HTN
none → BP may decrease as pregnancy progresses
How should you adjust your patient with CHTN whose BP is <120/80 early in pregnancy?
taper or discontinue
When would you want to reinstitute or initiate therapy for a patient with CHTN?
15 above their baseline
> 150/>95
signs of HTN end-organ damage
first line oral medication for chronic HTN
methyldopa
second line/higher risk pt medication for chronic HTN
labetalol
mild HTN without proteinuria or other signs of preeclampsia that develops after 20 weeks gestation and resolves by 12 weeks postpartum
gestational HTN
what could proteinuria indicate?
impaired kidney function, preeclampsia, dehydration
What is gestational HTN associated with?
hormones of pregnancy
what are you concerned about gestational HTN progressing into?
preeclampsia
New onset of HTN and proteinuria after 20 weeks → >140/>90, proteinuria >300 mg (24 hr urine)
preeclampsia
if your patient presents with preeclampsia prior to 20 weeks what should you think is going on?
molar pregnancy
occurrence of generalized convulsion and/or coma in the setting of preeclampsia without any other neurological condition
eclampsia
Symptoms of preeclampsia
swelling of hands and face, HTN, proteinuria, edema, headache, vision changes, liver pain
CNS dysfunction of severe preeclampsia
blurred vision, scotomata, alterned metnal status, severe headache
symptoms of liver capsule distention in severe preeclampsia
RUQ or epigastric pain
Serum transaminase concentration that is at least twice normal may indicate
hepatocellular injury
What BP qualifies as severe preeclampsia?
> 160/>110 2 times 15 min apart
Thrombocytopenia, oliguria, progressive renal insufficiency, fetal growth restriction, pulmonary edema, cyanosis, CVA, HELLP
severe preeclampsia
chronic HTN + new proteinuria + HTN and proteinuria prior to 20 weeks + sudden increase in BP + thrombocytopenia + elevated aminotransferase
preeclampsia superimposed on chronic HTN
Definitive treatment for preeclampsia
deliver the baby
what is major indicator for antihypertensive therapy in patient with preeclampsia?
prevent stroke (BP >160/>110)
acute treatment for preeclampsia
IV labetalol or hydralazine
SR nifedipine
long term treatment for preeclampsia
oral methyldopa or labetalol
risk factors for HTN in pregnancy
nulliparity preeclampsia in prior pregnancy age >40 or < 18 FH of HTN CHTN chronic renal disease APA syndrome or inherited thrombophilia vascular or CTD DM multifetal gestations BMI > 30 male partner whos partner has preeclampsia hydrops fetalis unexplained fetal growth restriction IVF
Points to include on physical when evaluating HTN in pregnancy
vitals HEENT (vision) cardiovascular respiratory abdomen (epigastric or RUQ pain) NM and extremities (reflex, clonus, edema) fetus (FM,NST)
lab tests to order in evaluating HTN in pregnancy
CBC (Hgb & platelets) renal (Cr, UA, albumin) liver (AST, ALT, ALP, LDH) coagulation (PT, PTT, INR, fibrinogen) urine protein (dipstick, 24 hr)
observation management for HTN in pregnancy
restrict activity
BP monitoring
s/s of preeclampsia
fetal growth and well being
acute therapy for HTN in pregnancy
IV labetalol or hydralazine
SR nifedipine
expectant tehreapy for HTN in pregnancy
oral labetalol, methyldopa, nifedipine
What medication can you give to prevent eclampsia?
MgSO4
contraindicated antihypertensives in pregnancy
ACEi and ARBs
Only cure for gestational HTN
delivery
Medications for postpartum management of preeclampsia
aldomet, labetalol, propranolol
what should mom avoid in the postpartum management of preeclampsia?
NSAID
what antihypertensive meds are safe with breast feeding?
methyldopa labetalol propranolol low dose ACEi CCB
Moms with preeclampsia are at increased lifetime risk of
CAD and CVA
