HTN in pregnancy Flashcards
What is chronic hypertension
> 140/90 prior to 20 weeks gestation
What is pregnancy induced HTN
new onset HTN >140/90 presenting after 20 weeks gestation
NO proteinuria
What is pre-eclampsia
New onset HTN (after 20 wks) PLUS proteinuria
BP must be elevated on 2 occasions, at least 6 hours apart
140+ or 90+
What is eclampsia
Onset of seizures in a woman with pre-eclampsia
RF for pre-eclampsia include
Nulliparity Hx of pre-eclampsia AMA Multiple gestation Diabetes Chronic HTN or renal disease FHx of pre=eclampsia Obesity
How does pre-eclampsia present
HTN Epigastric pain Headache Visual Sx (blurry vision, flashing lights, sparks) Edema Hyperreflexia Oliguria *BEWARE: "worst HA i've ever had, pulmonary edema, AMS, photopsia, scotoma
Define Mild pre-eclampsia
SBP 140+ or DBP 90+
Proteinuria 0.3g or more in 24 hours
Define severe pre-eclampsia
SBP 160+ or DBP 110+ Oliguria <500cc in 24 hours 3+g protein, or 5+g in 24 hours End organ damage Fetal compromis
Complications of pre-eclampsia include
HELLP;
Hemolysis
Elevate Liver enzymes
Low Platelet count
What labs should you repeat weekly in you have no signs of SEVERE pre-eclampsia
CBC Creatinine Liber enzymes 24 hr urine urine dipstick
What other tests help evaluate pre-eclampsia
Fetal non-stress test (15bpm increase for 15 seconds)
US (amniotic fluid volume, fetal weight)
How do you manage pre-eclampsia
All anti-HTN meds cross placenta.. assess risk vs benefit
If severe (SBP >160), NEED anti-HTN to decrease moms SV
*NEVER use an ace/arb or diuretic
What is M&M of mom with pre-eclampsia
15% death
AMI
stroke
cardiac failure
What is M&M of baby in pre-eclampsia
Poor oxygen transfer fetal growth restriction pre-term birth placental abruption stillbirth neonatal death
ACOG says this is first line for Chronic HTN Tx
Labetalol
Nifedipine
Methyldopa
*avoid Tx if BP is not >160/105 and no evidence of end organ damage (proteinuria)
