HTN Disorders in Pregnancy Flashcards

1
Q

What’s the difference between chronic vs. gestational HTN?

A
  • Chronic HTN is present before or recognized during first half of preg.
  • Gestational HTN is recognized after 20 weeks gestation
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2
Q

For pregnant patient w/ severe HTN (BP >160/110) what are the 3 drugs given for anti-hypertensive therapy?

A
  • Methyldopa
  • Labetalol
  • Nifedipine
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3
Q

What is needed for the diagnosis of preeclampsia?

A
  • HTN
  • Proteinuria
  • (Edema)
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4
Q

If pregnant pt presents with severe HTN after 38 weeks gestation what is next best step?

A

Delivery

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5
Q

What are 4 sx’s of preeclampsia?

A
  • Scotoma (blind spot)
  • Blurred vision
  • Epigastric and/or RUQ pain
  • Headache
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6
Q

What may be seen in the brain, heart, and lungs of patient with preeclampsia?

A
  • Brain = cerebral edema and/or fibrinoid necrosis, thrombosis, microinfarcts and petechial hemorrhages
  • Heart = absence of normal intravascular volume expansion (third spacing) and ↓ in circulating blood volume
  • Lungs = noncardiogenic pulmonary edema
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7
Q

Which level of proteinuria is associated with mild vs. severe preeclampsia?

A
  • Mild = proteinuria >300 mg/24-hr urine but <5 gms/24-hr or a single specimen urine protein:creatinine ratio of 0.3 mg/dL
  • Severe = proteinuria of at least 5gms/24-hr or 3+ protein on 2 random urine dips at least 4 hours apart
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8
Q

What are some sx’s associated with preeclampsia which would put someone in the severe category?

A
  • Oliguria (less than 500 mL in 24 hours) or renal insufficiency (serum Cr >1.1)
  • Cerebral or visual disturbances
  • Pulmonary edema
  • Epigastric or RUQ pain (think subscapular hematoma)
  • liver enzymes
  • Thrombocytopenia
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9
Q

When giving magnesium sulfate to patient with preeclampsia for seizure prophylaxis what is the loading dose and maintenance dose used; what should you be monitoring?

A
  • Loading dose is 4 gm bolus
  • Maintenance dose is 2 gm/hr
  • Monitor urine output and reflexes
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10
Q

What is the theraputic value (mg/dL) for magnesium sulfate when using prophylactically in patient with preeclampsia?

A

5-9 mg/dL

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11
Q

What is the first thing to do in patient with eclampsia; what is the first line treatment?

A
  • First thing to do is protect the airway
  • Magnesium sulfate is first-line tx
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12
Q

If the seizures of eclampsia are persistent after giving magnesium sulfate, what else can be given?

A

Lorezepam

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13
Q

What does HELLP syndrome stand for and is a variant of what?

A
  • Hemolysis, Elevated Liver enzymes and Low platelets
  • Variant of preeclampsia
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14
Q

What is the indication for delivery in patient with HELLP syndrome?

A

Immediate delivery

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15
Q

Which sx’s are common in HELLP syndrome?

A
  • RUQ pain
  • Epigastric pain
  • Nausea and vomiting are common
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16
Q

In patient with hx of preeclampsia, especially if accompanied by an adverse outcome, multifetal gestation, chronic HTN, diabetes, renal or autoimmune disease, what is given as a preventative measure?

A

Baby ASPIRIN starting at 12 weeks

17
Q

What is the management of preeclampsia without severe features (mild) at less than 37 weeks gestation?

A
  • Bed rest
  • Once (BPP) or twice (NST) weekly antepartum testing
  • Fetal growth ultrasound every 3-4 weeks
  • Office visits and lab eval.
  • Possibly hospitilization
18
Q

What is the management of preeclampsia without severe features (mild) at 37-40 weeks gestation?

A
  • If favorable cervix-induction
  • If unfavorable cervix - use a cervical ripening agent to begin induction
19
Q

What is the management of preeclampsia with severe features; when would you deliver; what are the anti-hypertensive medication options; what if <37 weeks?

A
  • Immediate hospitalization
  • Delivery if >34 weeks
  • Management of BP: hydralizine, labetalol, nifedipine
  • If <37 weeks administer corticosteroids and work towards delivery as long as pt and fetus are stable