HTN Disorders in Pregnancy - Wootton

Question 1

Mom’s risks associated w/ HTN in pregnancy

Answer 1

• MI, Cardiac failure, CVA, renal failure, hepatic failure

Question 2

Fetus’ risks associated w/ HTN in pregnancy

Answer 2

• Growth restriction
• Preterm birth
• Placental abruption
• Stillbirth
• Neonatal death

Question 3

How to manage mild chronic HTN (before pregnancy started)

Answer 3

• Anti-HTN drugs
• Prenatal visits
• Fetal monitoring
• Delivery 39-40 weeks

Question 4

Gestational HTN - definition

Occurs when?

Answer 4

HTN w/o any features of preeclampsia

Before 20 weeks

Question 5

Symptoms of preeclampsia (besides the big 3)

Answer 5

• Scotoma
• Blurred vision
• Epigastric/RUQ pain
• Headache

Question 6

Anything that affects ____ can be a risk factor for HTN (including preeclampsia)

Answer 6

Vascularity

Question 7

Preeclampsia –> RUQ pain

Answer 7

Subcapsular hematoma (can rarely lead to liver rupture)

Question 8

Severe features in preeclampsia

Answer 8

• BP > 160 (systolic) or 110 (diastolic)
• Proteinuria > 5 gms/day or 3+
• Oliguria
• Symptomatic (cerebral, visual, pulmonary edema, epigastric/RUQ, etc.)

Question 9

Preeclampsia – PE finding

Lab findings

Answer 9

Brisk reflexes/clonus

• Increased Hct, LDH, AST/ALT, uric acid
• Low platelets

Question 10

***3 major BP meds in preeclampsia

If less than 34 weeks?

Answer 10

• Hydralazine
• Labetalol
• Nifedipine

Steroids, work towards delivery if mom and baby are stable

Question 11

Preferred mechanism of birth

Answer 11

Vaginal delivery

Question 12

People that can’t get an epidural

Answer 12

Low platelets (could get hematoma on spinal cord)

Question 13

27, first pregnancy at 32 weeks, bilateral LE edema. Normal reflexes. Labs normal.

Answer 13

Normal - physiologic edema of pregnancy

Question 14

39, AA, 38 wks. BP high (new). 1+ proteinuria…Next step in evaluation?

BP still high, urine dip 2+, +3/4 reflexes w/ beats of clonus. Slightly high creatinine, low platelets, liver enzymes 2x normal. Dx?

Do what now?

Answer 14

Send to L&D – do lab studies

HELLP syndrome

Induce delivery (w/ steroids)

Question 15

21, 28 wks, headache unrelieved by Tylenol. Vision is a little blurred. No epigastric pain or N/V. Urinalysis = 5 gms protein in 24 hrs. High BP despite bed rest. Severely growth restricted infant.

Dx?
Next steps?

After traditional treatment modalities, BP still horrible. Next step?

Answer 15

Preeclampsia w/ severe features

Steroids (b/c pre-term), MgSO4, then work towards delivery

Antihypertensives (Hydralazine, Labetalol, Nifedipine)