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HTN disorders of Pregnancy Flashcards

1
Q

What are the three effects of hPL on maternal metabolism?

A
  • Decreases insulin sensitivity
  • Decreases maternal glucose utilization
  • Increases lipolysis
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2
Q

Are opioids contraindicated in pregnancy?

A

Yes

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3
Q

What is the most common medical condition in pregnancy?

A

HTN

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4
Q

What percent of all women in pregnancy have HTN?

A

6-8%

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5
Q

What happens to maternal BP early in pregnancy? Why? (2)

A

Decreases in the first trimester, d/t increased maternal blood volume, and decreased colloid oncotic pressure

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6
Q

The lowest maternal BP occurs when in pregnancy?

A

13-20 weeks gestation

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7
Q

Why is it particularly important to take BP readings early in the pregnancy?

A

To distinguish chronic HTN from HTN causes in pregnancy

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8
Q

What are the four types of pregnancy related HTN?

A
  1. Chronic HTN
  2. Gestational HTN
  3. Preeclampsia
  4. Preeclampsia superimposed on chronic HTN
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9
Q

What is the definition of chronic HTN? (2)

A
  • BP more than 140/90 prior to the first 20 weeks of pregnancy
  • BP remains elevated more than 12 weeks postpartum
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10
Q

Is there proteinuria with chronic HTN?

A

No

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11
Q

Chronic HTN is defined as having high BP how many weeks postpartum?

A

More than 12

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12
Q

What is mild HTN defined as? What are the complications that can arise from this in pregnancy?

A

DBP 90-110

No increase risk

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13
Q

What defines severe HTN in pregnancy?

A

DBP more than 110

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14
Q

Over what age is maternal HTN particularly concerning?

A

40 years

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15
Q

What percent of women with gestational HTN have a premature birth?

A

66%

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16
Q

What percent of women with gestational HTN have IUGR?

A

33%

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17
Q

What is the RR of fetal demise with maternal HTN?

A

3x

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18
Q

What is the RR of mortality of pregnant women if they have severe HTN in the first trimester?

A

50% increase

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19
Q

What placental abnormality can occur with HTN?

A

Placental abruption

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20
Q

What is placental abruption?

A

When the placenta separates before delivery

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21
Q

When (particularly) should lifestyle modifications be considered with maternal HTN?

A

When BP is “low” in first half of pregnancy with no renal insufficiencies

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22
Q

When do you start to treat HTN in pregnancy with meds?

A

If BP is more than 160/110

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23
Q

When should antiHTN meds be continued into pregnancy?

A
  • Multiple meds needed

- End organ dysfunction

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24
Q

What are the two major signs of preeclampsia? (2)

A
  • Proteinuria

- Sudden increase in BP

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25
When a woman develops preeclampsia, what aspects of the fetus should be measured? How often should this be done?
- Fundal height | - US 1 4 weeks starting at 28-32 weeks
26
What is the definition of gestational HTN? Is there proteinuria with this?
Nonproteinuric HTN after 20 weeks
27
What defines mild gestational HTN? Severe?
Less than 160/110 More than 160/110
28
Is transient HTN of pregnancy concerning?
As long as does not develop into preeclampsia
29
What is the treatment for mild gestational HTN?
Expectant
30
What is the treatment for severe gestational HTN?
Same management as for severe preeclampsia
31
What percent of US pregnancies have preeclampsia?
5-7%
32
What is the definition of gestational HTN?
New onset HTN and proteinuria after 20 weeks gestation, in a previously normotensive woman
33
What is the BP range that defines MILD preeclampsia? What amount of protein in the urine?
More than 140/90 0.3 g in a 24 hour urine
34
What are the signs of severe preeclampsia? (6)
- BP more than 160/110 - Thrombocytopenia - Impaired liver function - Progressive renal insufficiency - Pulmonary edema - New onset cerebral or visual disturbances
35
When does preeclampsia present?
At any point in the pregnancy
36
What is eclampsia?
Seizures
37
What are the age ranges that are a risk factor for preeclampsia?
Less than 20 or more than 35
38
What ethnicity has an increased risk for developing preeclampsia? What is the RR?
Black | 2x higher than white
39
Is nulliparity or multiparity a risk factor for the development of preeclampsia?
Nulliparity
40
What is the role of stress with preeclampsia? Obesity?
Increases the risk
41
What are the hematological abnormalities that can increase the risk for preeclampsia? (2)
- Thrombophilias | - Antiphospholipid antibody syndrome
42
True or false: having preeclampsia in a previous pregnancy is a risk factor for developing it again
True
43
Are multifetal pregnancies at an increased risk for preeclampsia?
Yes
44
Is there an increased or decreased risk for preeclampsia for the following: - Chromosome abnormalities - Hydrops fetalis - Oocyte donation - Structural congenital abnormalities
All increased
45
What is the prevalence of eclampsia in the US?
1 in 2000
46
What is HELLP syndrome?
Preeclamptic s/sx with: - Hemolysis - elevated LFTs - Low platelets
47
When are most cases of HELLP syndrome diagnosed?
antepartum
48
What defines a thrombocytopenia with HELLP syndrome?
Less than 100,000
49
What defines elevated LFTs with HELLP syndrome?
More than 100
50
LDH greater than what value indicates hemolysis?
600
51
Bili of more than what indicates hemolysis?
1.2 mg/dL
52
True or false: the abnormal PBS can be seen with hemolysis in HELLP syndrome
True
53
What are the prevention measures for preeclampsia?
None known
54
What is the ultimate cure for preeclampsia?
-Delivery
55
When is inpatient management indicated for preeclampsia? (3)
- Noncompliant pt - No ready access to medical care - Progressive s/sx
56
What are the two key goals of treating preeclampsia?
Control HTN | Prevent seizures
57
What is the treatment for seizures 2/2 preeclampsia?
MgSO4, then pre for delivery after seizure stopped
58
What are the three fetal indications for a delivery with preeclampsia?
- severe IUGR - Nonreassuring fetal surveillance - Oligohydramnios
59
Over how many weeks gestation is delivery indicated for preeclampsia?
More than 37 weeks
60
What is the preventative treatment for seizures after delivery?
MgSO4
61
What are the four major postpartum complications that can occur with preeclampsia?
- Pulmonary edema - Heart failure - HTN encephalopathy - Renal failure
62
What is the definition of IUGR?
Estimated fetal weight less than the 10th percentile
63
What is needed to diagnose IUGR?
Serial US
64
What is asymmetric IUGR?
IUGR is disproportionately lagging in abdominal growth (HC more than Abdominal circumference)
65
True or false: asymmetric IUGR is "abdomen sparing"
False--"head sparing"
66
What is symmetric IUGR?
All parts of the baby are small
67
True or false: symmetric IUGR can sometimes be caused by constitutionally small parents
True
68
How can DM mothers have IUGR?
Vascular disease causing growth restriction
69
Is HTN or preeclampsia a risk factor for the development of IUGR?
Yes
70
What is AFP used as a screen for? What relative value of this indicates a risk for IUGR?
Neural cord defects | Elevated
71
True or false: Multiple gestations is a protective factor against IUGR
False--risk factor
72
What are the three major infectious agents that can cause IUGR?
- CMV - Toxo - Rubella
73
What is a key finding on US that may concern you for IUGR?
Placental abnormalities
74
How do you screen for IUGR?
- Measure maternal fundal height | - AFP
75
What are the US findings that are used to diagnose IUGR? (3)
- Absolute measurements - Percentile rank - Rate of growth
76
Estimated fetal weight and/or an abdominal circumference of less than what percentile suggests IUGR?
10th
77
True or false: serial USs allow for definitive diagnosis of IUGR
False--only at delivery
78
What is the treatment for IUGR before 34 weeks? after
Expectant if before Delivery if after
79
True or false: you need to have both retarded HC and AC to diagnose IUGR
True
80
What are the three antenatal tests that can be used to assess for IUGR?
- Biophysical profile - Nonstress test - Umbilical artery doppler
81
What are the risks of IUGR?
- Meconium aspiration - Hypoglycemia - Hyperbilirubinemia - Seizures

OB/GYN (33 decks)

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