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Gyne > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is hypertension in pregnancy

A

Systolic >140
And\OR
Diastolic >90

(More or equal)

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2
Q

What are the conditions that should be achieved during measurment of the BP?

A
  • sitting\lat decubitus
  • rested
  • level of rt atrium
  • the cuff should be >1.5x c of upper limb
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3
Q

Why are we seeing more HTN and DM in pregnancy

A

Women getting preg at older age

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4
Q

What are the types of hypertensive disorders in pregnancy

A
  • preeclampsia\eclampsia
  • chronic HTN
  • chronic HTN + superimposed pre-eclampsia
  • gestational HTN
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5
Q

How to diagnose pre-eclampsia

A

1- HTN + proteinurea (after 20wks)

2- HTN + organ dysfunction (after 20 wks)

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6
Q

What is considered proteinurea in pre-eclampsia

A

1- > or equal to 0.3g of protein in 24 urine collection

2- > or equal to 30mg\dl (+1) protein\creatinine ratio

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7
Q

What is pre-eclampsia with severe features

A

1- severe HTN: BP (S>160-D>110)
2- organ damage (renal, cerebral, visual, pulmonary, liver)
3- thrombocytopenia

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8
Q

What are the end organ damage present in pre-eclamspia with severe features

A

1- renal insufficiency
2- elevated liver enzyme\ epigastric & RUQ pain\ thrombocytopenia q
3- cerebral\visual disturbance

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9
Q

What is the renal insufficiency defined as:

A
  • Cr>1.1

- doubling of baseline

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10
Q

When is liver enzyme considerd elevated

A

AST or ALT 2x normal levels

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11
Q

What are the clinical presentation that may increase your suspicion of pre-eclampsia?

A

SOB, Headache, blurred vision, right upper quadrant pain

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12
Q

What is HELLP syndrome

A

Hemolysis, elvated liver, low platelet

+ pre-eclampsia

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13
Q

How to differentiate thrombocytopenia in pre-eclampsia?

A

Very rapid decrease in platelet count

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14
Q

what is the state of BP in HELLP syndrome?

A

Either absent HTN, very severe or mild

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15
Q

Define eclampsia

A

new onset Grand-mal seizure in women w\pre-eclampsia (not due to other causes)

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16
Q

How to treat eclampsia

A

Magnesium sulfate

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17
Q

When does these seizure occur in eclampsia

A

Either before labor, during labor, after delivery (24-48hrs)

18
Q

How to prevent eclampsia

A

Timely recognition and delivery of women with severe pre-eclampsia

19
Q

How to identify chronic hypertension with superimposed pre-eclampsia?

A

patient is already known for chronic HTN

  • patient develops new onset proteinurea after 20th weeks of gestation
  • patient already has proteinurea, develop sudden increase in proteinurea or BP or new symptoms
20
Q

Give an example of HTN w\superimposed pre-eclampsia

A

Patient w\nephrotic syndrome that worsens the HTN

21
Q

What is gestational hypertension

A

HTN w\out proteinurea or organ dysfunction

  • after 20wks
  • within 48 to 72 hours of delivery & resolves by 12 weeks post-partum
22
Q

What are the risk factors for pre-eclampsia

A 
1- primaparity 
2- first degree relative with hx or pre-eclampsia 
3- prev pre-eclampsia 
4- chronic HTN, obesity, cKD, DM, SLE
5- maternal age >40
6- multiple gestations
23
Q

What is the pathophysiology of pre-eclampsia

A

1- lack of decidulization of myometrium
2- glomorulaar capillary endotheliosis
3- ischemia, hemorrhage, necrosis (liver, eye, brain); due to arteriolar constriction

(Incerased vascular resistance)

24
Q

What is the end result of lack dicidulization, endothliosis.

A

Placental infarction

25
Q

Having family hx or pre-eclampsia increase risk by

A

3x

26
Q

After placental ischemia, what will increase?

A

Circulating SFLT1 % SEng

27
Q

All the problem s of visual disterbuance, headache, cerebral edema and seizures in pre-eclampsia are caused by

A

Oxidative stress > presistant hypoxia = placental ischemia.

28
Q

What are the important questions to ask before managing pre-eclampsia

A

1- severe features?
2- fetal compromise?
3- fetal maturation

29
Q

What to do if the mother has severe features of pre-eclampsia

A

Deliver her immidiately

30
Q

Name examples of fetal compromise that affect the management of pre-eclampsia

A

IUGR, oligohydarminos, heart rate abnormalities

31
Q

If the baby was 36- or 37 and the mother develops pre-eclampsia, what to do?

A

Deliver her

32
Q

What is the definitive treatment of pre-eclampsia

A

Delivery

33
Q

What are the investigations you’d like to order in pre-eclampsia?

A

1- CBC, platelet, LDH (D-dimer, coagulation, smear)
2- renal (Bun, creatinine, uric acid, urinalysis, 24hr urine for protein & creatinine)
3- liver (AST, ALT, bili)

34
Q

What is the inrtapartum management of pre-eclampsia

A
  • magnesium sulfate (prevent seizure)
  • control BP (labetalo, hydralzine, nifedipine)
  • fetal monitoring
  • fluid restriction
35
Q

What is the toxicity of mgSO4

A

Loss of patellar reflex, warmth, somnolence, slurred speech, paralysis of resp&raquo_space; cardiac arrest

36
Q

What are the side effects of hydralzine

A

Headache, tachycardia, flushing, vomiting

Vasodilator

37
Q

What is the drug of choice for short term control of pre-eclampsia HTN

A

Hydralzine

38
Q

What is the mechanism of action of labetalol or hydrochloride

A
  • b-blocker

- a- blocker

39
Q

What are the current AHT medications for pre-eclampsia?

A

Labetalol and hydrochloride

avoid in HF and asthma

40
Q

What are the complications of pre-eclampsia?

A
  • recurrance

- long term CVD and chronic HTN

41
Q

How to avoid recurrance of pre-eclampsia after first time?

A

By low dose asprin

42
Q

What are the complications of pre-eclampsia on fetus

A

IUGR, prematurity, acute\chronic fetal distress

Gyne (18 decks)

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