Hypertension Flashcards
Level of proteinuria that is diagnostic of Preeclampsia?
P/Cr ratio >/= 0.3
> /= 300 mg/24 hrs
Pre E Severe Features
BP >/= 160/110
Chest pain, Dyspnea, pulm edema
Cr > 1.1 or double baseline
New HA/Visual disturbances
Plts < 100 k
AST/ALT > 2 x baseline
Persistent RUQ pain/epigastric pain w/out other other causes
How do you screen for preeclampsia risk?
Based on Hx
Personal or Fm Hx of Pre E
Multiple gestation
Chronic HTN
Type 1/2 DM
Autoimmune disease
Get Baseline UPC/HELLP labs
Start ASA 81 mg QD for any hx of hypertensive disease
Who gets ASA in pregnancy?
1 high risk criteria:
- Hx of Pre E
- Chronic HTN
- Renal Disease
- Twins
- Pre gestational DM
- Autoimmune disease (APLS, Lupus)
OR 1 or more moderate risk factors
- AMA
- Nulliparity
- Obesity
- African American
- Low socioeconomic status
- Fm Hx of Pre E
- Previous SGA, low birth weight
- > 10 years since previous pregnancy
- IVF
When should you start ASA?
Between 12-28 weeks
MOST EFFECTIVE IF STARTING PRIOR TO 16 WEEKS
Therapeutic range of Mg?
4.8-5.9 mg/dL
Physical Exam findings of Mag Toxicity?
Loss or reflexes > 9 mg/dL
Respiratory arrest > 12 mg/dL
Cardiac arrest > 30 mg/dL
Antidote of Mag Toxicity?
STOP INFUSION
Calcium gluconate 1 gm (10 cc) IV over 3 minutes
Max dose of IV labetalol?
Total 300 mg
Give 20, 40, ,80 mg Q10 mins
Max dose of Hydralazine?
Total 30 mg
Give 5, 10 mg Q20 mins
Nifedipine dosing?
PO 10, 20, 20 Q20 mins
Preeclampsia w/ Myasthenia Gravis?
CAN’T GET MAG! (risk of respiratory arrest)
Phenytoin (monitor with EKG)
Diazepam (be able to intubate)
Secondary causes of hypertension?
Illicit drug use (meth or cocaine)
Renal artery stenosis/ Renal disease
Sleep Apnea
What to do if no IV and need to start Mag?
Can give IM 10 g
Give 5 g in each butt cheek
Management of Eclamptic Seizure
Call for help
Position in lateral decubitus
Prevention of aspiration
Oxygen, check vitals
Eclamptic seizures are self limiting!!!
Give 2-4 g IV Mag over 5 minutes (prevents next seizure)
What is refractory eclamptic seizure?
What should you do?
Still seizing 20 mins after bolus
OR
More than 2 occurrences
Does Eclampsia require a C/S?
Women should be delivered in a timely fashion
Eclampsia by itself is NOT an indication for CS
After stabilization consider other factors: GA, presentation, cervix
*High rate of induction failure if < 30 weeks
What can you expect FHT to do during seizure?
Indication for CS?
During Seizure:
Prolonged decelerations
Fetal Bradycardia
Increase in uterine contractility
After Seizure:
Recurrent decelerations
Tachycardia
Minimal variability
***Maternal resuscitation is usually followed by normalization of FHT
Additional agents for recurrent eclamptic seizures?
Diazepam 5-10 mg IV every 5-10 minutes
MAX DOSE 30 mg
When should you start meds prenatally for a chronic HTN? What is the goal pressures?
Start if persistently > 140/90
Titrate to < 140/90 during pregnancy
Maternal risks of cHTN in pregnancy?
Increased risk of Pre E
CVA/MI/Pulmonary edema
Worsening renal function
GDM
C/S and PPH
Placental abruption
Fetal risks of cHTN in pregnancy?
FGR
IUFD
Preterm Birth
Delivery timing for hypertensive disorders?
CHTN, uncomplicated, no meds 38 - 39w6d
CHTN, uncomplicated, on meds 37 -39w6d
Pre E w/out SF or GHTN @ 37 wks
Pre E w/ SF @ 34 wks
How does ASA reduce risk of Pre E?
Reduces thromboxane production by platelets
Thrombozane promotes vasocontriction and platelet aggregation
*decreases vascoconstriction and platelet aggregation
Start 12-28 weeks, best time to start is < 16 wks
Daily low dose 81 mg/day ASA has not been associated with signficant maternal or fetal complications!!!!
