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OB/GYN > HTN disorders of Pregnancy > Flashcards

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
Q

When a woman develops preeclampsia, what aspects of the fetus should be measured? How often should this be done?

A
  • Fundal height

- US 1 4 weeks starting at 28-32 weeks

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26
Q

What is the definition of gestational HTN? Is there proteinuria with this?

A

Nonproteinuric HTN after 20 weeks

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27
Q

What defines mild gestational HTN? Severe?

A

Less than 160/110

More than 160/110

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28
Q

Is transient HTN of pregnancy concerning?

A

As long as does not develop into preeclampsia

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29
Q

What is the treatment for mild gestational HTN?

A

Expectant

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30
Q

What is the treatment for severe gestational HTN?

A

Same management as for severe preeclampsia

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31
Q

What percent of US pregnancies have preeclampsia?

A

5-7%

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32
Q

What is the definition of gestational HTN?

A

New onset HTN and proteinuria after 20 weeks gestation, in a previously normotensive woman

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33
Q

What is the BP range that defines MILD preeclampsia? What amount of protein in the urine?

A

More than 140/90

0.3 g in a 24 hour urine

34
Q

What are the signs of severe preeclampsia? (6)

A
  • BP more than 160/110
  • Thrombocytopenia
  • Impaired liver function
  • Progressive renal insufficiency
  • Pulmonary edema
  • New onset cerebral or visual disturbances
35
Q

When does preeclampsia present?

A

At any point in the pregnancy

36
Q

What is eclampsia?

A

Seizures

37
Q

What are the age ranges that are a risk factor for preeclampsia?

A

Less than 20 or more than 35

38
Q

What ethnicity has an increased risk for developing preeclampsia? What is the RR?

A

Black

2x higher than white

39
Q

Is nulliparity or multiparity a risk factor for the development of preeclampsia?

A

Nulliparity

40
Q

What is the role of stress with preeclampsia? Obesity?

A

Increases the risk

41
Q

What are the hematological abnormalities that can increase the risk for preeclampsia? (2)

A
  • Thrombophilias

- Antiphospholipid antibody syndrome

42
Q

True or false: having preeclampsia in a previous pregnancy is a risk factor for developing it again

A

True

43
Q

Are multifetal pregnancies at an increased risk for preeclampsia?

A

Yes

44
Q

Is there an increased or decreased risk for preeclampsia for the following:

  • Chromosome abnormalities
  • Hydrops fetalis
  • Oocyte donation
  • Structural congenital abnormalities
A

All increased

45
Q

What is the prevalence of eclampsia in the US?

A

1 in 2000

46
Q

What is HELLP syndrome?

A

Preeclamptic s/sx with:

  • Hemolysis
  • elevated LFTs
  • Low platelets
47
Q

When are most cases of HELLP syndrome diagnosed?

A

antepartum

48
Q

What defines a thrombocytopenia with HELLP syndrome?

A

Less than 100,000

49
Q

What defines elevated LFTs with HELLP syndrome?

A

More than 100

50
Q

LDH greater than what value indicates hemolysis?

A

600

51
Q

Bili of more than what indicates hemolysis?

A

1.2 mg/dL

52
Q

True or false: the abnormal PBS can be seen with hemolysis in HELLP syndrome

A

True

53
Q

What are the prevention measures for preeclampsia?

A

None known

54
Q

What is the ultimate cure for preeclampsia?

A

-Delivery

55
Q

When is inpatient management indicated for preeclampsia? (3)

A
  • Noncompliant pt
  • No ready access to medical care
  • Progressive s/sx
56
Q

What are the two key goals of treating preeclampsia?

A

Control HTN

Prevent seizures

57
Q

What is the treatment for seizures 2/2 preeclampsia?

A

MgSO4, then pre for delivery after seizure stopped

58
Q

What are the three fetal indications for a delivery with preeclampsia?

A
  • severe IUGR
  • Nonreassuring fetal surveillance
  • Oligohydramnios
59
Q

Over how many weeks gestation is delivery indicated for preeclampsia?

A

More than 37 weeks

60
Q

What is the preventative treatment for seizures after delivery?

A

MgSO4

61
Q

What are the four major postpartum complications that can occur with preeclampsia?

A
  • Pulmonary edema
  • Heart failure
  • HTN encephalopathy
  • Renal failure
62
Q

What is the definition of IUGR?

A

Estimated fetal weight less than the 10th percentile

63
Q

What is needed to diagnose IUGR?

A

Serial US

64
Q

What is asymmetric IUGR?

A

IUGR is disproportionately lagging in abdominal growth (HC more than Abdominal circumference)

65
Q

True or false: asymmetric IUGR is “abdomen sparing”

A

False–“head sparing”

66
Q

What is symmetric IUGR?

A

All parts of the baby are small

67
Q

True or false: symmetric IUGR can sometimes be caused by constitutionally small parents

A

True

68
Q

How can DM mothers have IUGR?

A

Vascular disease causing growth restriction

69
Q

Is HTN or preeclampsia a risk factor for the development of IUGR?

A

Yes

70
Q

What is AFP used as a screen for? What relative value of this indicates a risk for IUGR?

A

Neural cord defects

Elevated

71
Q

True or false: Multiple gestations is a protective factor against IUGR

A

False–risk factor

72
Q

What are the three major infectious agents that can cause IUGR?

A
  • CMV
  • Toxo
  • Rubella
73
Q

What is a key finding on US that may concern you for IUGR?

A

Placental abnormalities

74
Q

How do you screen for IUGR?

A
  • Measure maternal fundal height

- AFP

75
Q

What are the US findings that are used to diagnose IUGR? (3)

A
  • Absolute measurements
  • Percentile rank
  • Rate of growth
76
Q

Estimated fetal weight and/or an abdominal circumference of less than what percentile suggests IUGR?

A

10th

77
Q

True or false: serial USs allow for definitive diagnosis of IUGR

A

False–only at delivery

78
Q

What is the treatment for IUGR before 34 weeks? after

A

Expectant if before

Delivery if after

79
Q

True or false: you need to have both retarded HC and AC to diagnose IUGR

A

True

80
Q

What are the three antenatal tests that can be used to assess for IUGR?

A
  • Biophysical profile
  • Nonstress test
  • Umbilical artery doppler
81
Q

What are the risks of IUGR?

A
  • Meconium aspiration
  • Hypoglycemia
  • Hyperbilirubinemia
  • Seizures

OB/GYN (33 decks)

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