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Obstetrics > HTN and Preeclampsia > Flashcards

HTN and Preeclampsia Flashcards

1
Q

this hormone cuases dilation of the BV due to relaxing of the BV walls

A

elastin

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2
Q

What is considered HTN?

A

SBP > 140 and/or DBP >90

2 times 4 hours apart

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3
Q

4 categories of HTN

A

chronic
gestational
preeclampsia/eclampsia/HELLP
preeclampsia + CHTN

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4
Q

What is HELLP?

A

HTN, elevated LFT, low platelets

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5
Q

“preexisting HTN”

A

chronic HTN

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6
Q

HTN presents before the 20th week of pregnancy or persists longer than 12 weeks postpartum

A

chronic HTN

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7
Q

Prenatal care for chronic HTN

A

EKG, UA, urine culture, sCr, glucose, electrolytes, 24 hr urine, CMP, tests for renal disease (trying to r/o DM),

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8
Q

1 cause of infant and maternal mortality

A

hemolysis

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9
Q

what should mom with chronic HTN take during pregnancy?

A

low dose Aspirin (81-150 mg)

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10
Q

Treatment for uncomplicated mild essential HTN

A

none → BP may decrease as pregnancy progresses

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11
Q

How should you adjust your patient with CHTN whose BP is <120/80 early in pregnancy?

A

taper or discontinue

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12
Q

When would you want to reinstitute or initiate therapy for a patient with CHTN?

A

15 above their baseline
> 150/>95
signs of HTN end-organ damage

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13
Q

first line oral medication for chronic HTN

A

methyldopa

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14
Q

second line/higher risk pt medication for chronic HTN

A

labetalol

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15
Q

mild HTN without proteinuria or other signs of preeclampsia that develops after 20 weeks gestation and resolves by 12 weeks postpartum

A

gestational HTN

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16
Q

what could proteinuria indicate?

A

impaired kidney function, preeclampsia, dehydration

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17
Q

What is gestational HTN associated with?

A

hormones of pregnancy

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18
Q

what are you concerned about gestational HTN progressing into?

A

preeclampsia

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19
Q

New onset of HTN and proteinuria after 20 weeks → >140/>90, proteinuria >300 mg (24 hr urine)

A

preeclampsia

20
Q

if your patient presents with preeclampsia prior to 20 weeks what should you think is going on?

A

molar pregnancy

21
Q

occurrence of generalized convulsion and/or coma in the setting of preeclampsia without any other neurological condition

A

eclampsia

22
Q

Symptoms of preeclampsia

A

swelling of hands and face, HTN, proteinuria, edema, headache, vision changes, liver pain

23
Q

CNS dysfunction of severe preeclampsia

A

blurred vision, scotomata, alterned metnal status, severe headache

24
Q

symptoms of liver capsule distention in severe preeclampsia

A

RUQ or epigastric pain

25
Q

Serum transaminase concentration that is at least twice normal may indicate

A

hepatocellular injury

26
Q

What BP qualifies as severe preeclampsia?

A

> 160/>110 2 times 15 min apart

27
Q

Thrombocytopenia, oliguria, progressive renal insufficiency, fetal growth restriction, pulmonary edema, cyanosis, CVA, HELLP

A

severe preeclampsia

28
Q

chronic HTN + new proteinuria + HTN and proteinuria prior to 20 weeks + sudden increase in BP + thrombocytopenia + elevated aminotransferase

A

preeclampsia superimposed on chronic HTN

29
Q

Definitive treatment for preeclampsia

A

deliver the baby

30
Q

what is major indicator for antihypertensive therapy in patient with preeclampsia?

A

prevent stroke (BP >160/>110)

31
Q

acute treatment for preeclampsia

A

IV labetalol or hydralazine

SR nifedipine

32
Q

long term treatment for preeclampsia

A

oral methyldopa or labetalol

33
Q

risk factors for HTN in pregnancy

A 
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
34
Q

Points to include on physical when evaluating HTN in pregnancy

A 
vitals
HEENT (vision) 
cardiovascular 
respiratory 
abdomen (epigastric or RUQ pain) 
NM and extremities (reflex, clonus, edema)
fetus (FM,NST)
35
Q

lab tests to order in evaluating HTN in pregnancy

A 
CBC (Hgb &amp; platelets)
renal (Cr, UA, albumin)
liver (AST, ALT, ALP, LDH)
coagulation (PT, PTT, INR, fibrinogen)
urine protein (dipstick, 24 hr)
36
Q

observation management for HTN in pregnancy

A

restrict activity
BP monitoring
s/s of preeclampsia
fetal growth and well being

37
Q

acute therapy for HTN in pregnancy

A

IV labetalol or hydralazine

SR nifedipine

38
Q

expectant tehreapy for HTN in pregnancy

A

oral labetalol, methyldopa, nifedipine

39
Q

What medication can you give to prevent eclampsia?

A

MgSO4

40
Q

contraindicated antihypertensives in pregnancy

A

ACEi and ARBs

41
Q

Only cure for gestational HTN

A

delivery

42
Q

Medications for postpartum management of preeclampsia

A

aldomet, labetalol, propranolol

43
Q

what should mom avoid in the postpartum management of preeclampsia?

A

NSAID

44
Q

what antihypertensive meds are safe with breast feeding?

A 
methyldopa
labetalol
propranolol
low dose ACEi 
CCB
45
Q

Moms with preeclampsia are at increased lifetime risk of

A

CAD and CVA

Obstetrics (17 decks)

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