htn disorders of pregancy Flashcards
htn impact
maternal mobility and mortality
earlier = higher risk for severe preE
gestation htn = increased r/o chronic htn later
obesity link
r/o placental abruption, preterm, IUGR
gestational htn
3BP >/= 140 or 90, after 20 wk, no proteinuria, chronic if persist 6+ week after delivery
preeclampsia
20 wk with proteinuria, mild or severe
rf: chronic htn, renal disease, DM, Rh incomp, primigravidity (1st pregnancy), fam hx, <20 yo or >40 yo, multiple gestation, IVF, new paternity
preeclampsia patho
unknown etiology
prostacyclin is a vasodilator that is decreased in preeclampsia allowing for vasoconstriction and reduces renal perfusion. decreased placental perfusion results in hypoxia
htn -> decreased placental perfusion
cell damage causes: vasoconstriction, activation of coag cascae, IV fluid redistribution
end result is decreased organ perfusion
start lowdose aspirin if at risk
preeclampsia patho - normal pregnancy
increase blood plasma volume -> vasodilation -> decreased systemic vascular resistance -> increased CO -> decreased colloid osmotic P
preeclampsia cm - maternal
BP: normal, mild, severe
s/s: epigastric pain (liver), CNS (blurred vision, HA), bleeding, n/v, visual disturbances, HA, irritable/hyperreflexia, retinal edema, retinal arteriolar narrowing (decreased retinal perfusion)
fibrinolysis hemolysis: HELLP, renal fail, DIC
capillary leak: proteinuria, facial edema, pulmonary edema, ascites, pleural effusions
preeclampsia cm - fetal
vascular stillbirth, abruption, IUGR, abnormal UA doppler, oligohydraminos
preeclampsia labs
CBC, liver enzymes (LDH, AST, ALT), chm pannel (BUN, creatinine, glucose, uric acid), type and screen and/or crossmatch
24 hr collection for protein and creatinine clearance (show how much is being lost)
protein dipsticks or protein/creatinine clearance ratio
preeclampsia cm - mild
> /= 140 OR 90 on 2 occasions at least 4 hrs apart with previously normal BP
proteinuria >300mg/24hr
protein/creatinine ratio >/= 0.3
1+ urine dipstick (if only method available)
edema/weight gain (not diagnostic)
OR
increase BP with any of the following w/o proteinuria: plt <100,000, cerebral or vision changes, serum creatinine [] >1.1 or doubling of serum creatinine [] in absence of renal disease, pulmonary edema, or liver enzymes >twice upper limit of normal
preeclampsia cm - severe
> /= 160 OR 110 on 2 occasions at least. 4 hrs apart with pt on bedrest (unless on antihypertensives)
proteinuria >/= 300mg/24hr
plt <100,000
pulmonary edema
new cerebral or vision changes
liver enzymes >twice upper limit of normal
severe, persistent epigastric pain
preeclampsia tm - home
mild
educate on worsening
rest, lateral positioning, daily BP, weight, and fetal movement counts
preeclampsia tm - hospital
mild
bedrest (side), weigh, S worse, BP q6, mod-high protein diet, mod Na
fetal movement record, biophysical profile, doppler velocimetry, serial US
dont need to check for proteinuria, more freq NST and AFI
preeclampsia tm - severe
complete bed rest, decreased env stimuli, anticonvulsant therapy (mgso4), F+E replace, corticosteroids (fetal lungs), antihypertensives (labetalol and hydralazine; procardia good for postpartum period)
acute control of severe htn
persistant >15 min, >160 or >105
IV labetalol (CI = asthma), IV hydralazine (CI = tachy), oral nifedipine (CI = tachy)
prevent convulsions
IV mgso4 - dont leave pt during bolus, will feel hot
loading dose and maintenance
if convulsion: bolus
treat: eclampsia, severe preE, HELLP
