Hypertension and Preeclampsia Flashcards
Whats is the definition of severe range blood pressures
greater than 160/110
definition of Hypertension in pregnanacy
140/90 measured on two occasions AT LEAST 4 hours apart
What level of protein in a 24 hour urine indicate proteinura?
> 300mg per 24 hours
In a blood draw what protein/creatinine ration signals proteinura?
> 0.3mg/dL
On a urine dipstick test what reading indicates proteinura? How accurate is it?
2+ on a dipstick least accurate method. 24 urine more accurate.
What is the definition of new renal insufficiency in pre-eclampsia
Creatinine > 1.1 mg/dL OR a doubling of creatinine. Good reason for baseline labs
Preeclampsia with severe features is BP of 160SBP OR DBP over 110 (two readings 4 hours apart) AND at least one of which 6 symptoms?
- Platelets less that 100,000
- Increased Liver Enzymes (LFT) twice normal or more
- Severe PERSISTENT RUQ/Epigastric Pain
- New renal insufficiency
- Pulmonary edema
- Neurological changes such as Headache and Visual disturbances
What are high risk factors for preeclampsia (6)? If a patient has any one of these the should be offered prophylactic aspirin therapy.
- HX of preeclampsia
- Mutifetal gestaion
- Chronic hypertension
- Type 1 or 2 diabetes
- Renal disease
- Autoimmune disease
What are moderate risk factors for preeclampsia (6)? Clinically consider low dose aspirin therapy if a patients has MORE than on of these risk factors.
- Nulliparity
- BMI > 30
- Family HX of preeclampsia (Mother or sister)
- Sociodemographic factors. African American or Low Socioeconomic status
- AMA
- Personal history (i.e. low birth weight, SGA, previous adverse pregnancy outcome, or >10 year pregnancy interval
What are the cardiovascular effects of preeclampsia?
Hypertension, increased cardiac output and systemic vascular resistance.
What are the hematologic effects of preeclampsia (3) ?
- Hypovolemia
- Low oncotic pressure with third spacing of fluid
- Microangiopathic hemolytic anemia, thrombocytopenia
What are the neurologic effects of preeclampsia (6) ?
- Hyperreflexia
- Visual disturbances
- Headache
- cerebral edema
- Seizures
- Posterior reversible encephalopathy syndrome (PRES)
What is the pulmonary effect of preeclampsia (1) What is the mechanism?
Pulmonary edema. Reduced colloid osmotic pressure leads to cappillary leak
What are the renal effects of preeclampsia (4) ?
- Decreased glomerular filtration rate
- proteinuria
- oliguria,
- Acute Tubular Necrosis (ATN)
What are the hepatic effects of preeclampsia (3) ?
- Periportal hemorrhage
- fibrin deposition
- hepatocyte disruption with necrosis
What are the possible fetal effects of preeclampsia (3) ?
Placental abruption
- IUGR
- oligohydramnios
- Distress
- Increased morbidity and mortality
Describe the pathway of Liver damage in preeclampsia and the expected change in lab values. (HTN may or may not be present at outset of pathway. ).
Subcapsular hemorrhage –>Strech of capsule and RUQ pain –> Liver rupture with hemoperitoneum and hypovolemic shock.
Labs that will be lowered Platlets, Fibrinogen, and Hematocrit.
Labs that will be elevated: clotting time measured as partial thrombolplastin time (PT/ PTT) and Liiver Function tests (ALT and AST)
What are the index values for LFTs? What value signals hepatic issue in pregnancy?
alanine aminotransferase (ALT) 7-56 U/L aspartate aminotransferase (AST) 10-40 U/L
What is the antepartum management of chronic hypertension (3)?
- Serial measurement of BP (at home and in office)
- Serial fetal growth ultrasound
- Antenatal surveillance with non-stress tests and AFI.
What is the management of Gestational Hypertension?
- Weekly assessment for proteinuria, platelets, LFTs, and creatinine
- Serial measurement of blood pressure (at home and in office)
- Serial fetal growth ultrasound
- Antenatal surveillance with non-stress test and AFI
What is the management preeclampsia WITHOUT severe features?
Close outpatient vs inpatient management (depending on aggregate risk factors)
Daily assessment for symptoms and fetal movement
Daily BP assessment
Weekly laboratory assessment (LFTs, platelets, creatinine)
2x weekly antenatal testing if outpatient, daily if inpatient
What is the management preeclampsia WITH severe features?
Inpatient hospital management
Serial fetal growth ultrasound
Daily antenatal testing
What is the goal BP range after treatment with antihyptensive agents?
SBP 120 -160
DBP 80 -110
When do you initiate antihyptensive therapy?
Fro persistent SBP > 160 or DPB > 110
