Hypertension and Pregnancy

Question 1

What is the pattern of blood pressure in pregnancy?

Answer 1

Decreases throughout pregnancy due to decreased SVR, reaches trough at mid 2nd trimester then back to baseline slowly during 3rd trimester

Question 2

What is the underlying pathophysiology in preeclampsia?

Answer 2

Arteriolar constriction and intravascular depletion 2/2 generalized transudative edema that leads to end organ damage
Thought to be due to circulating antigens or antibodies

Question 3

What are the symptoms of preeclampsia?

Answer 3

Decreased blood flow to placenta = abruption or fetal hypoxia, IUGR
Maternal seizure/stroke
Pulmonary edema
thrombocytopenia and DIC
HELLP

Question 4

What are the signs of HELLP?

Answer 4

RUQ pain/epigastric pain
N/V
elevated LDH and bilirubin
elevated LFTs
thrombocytopenia

Question 5

What is gestation hypertension?

Answer 5

BP > 140/90 that occurs during pregnancy, and resolves by 12 weeks after pregnancy

Question 6

How is preeclampsia diagnosed?

Answer 6

BP > 140/90 and urinary protein > .3 g per 24 hours

or protein/cr ratio> 0.3

Question 7

What are signs of severe preeclampsia?

Answer 7

Neurological changes (headaches)
Vision changes
BP > 160/110
Pulmonary edema
Platelets  2x nl
Oliguria

Question 8

What is the treatment for preeclampsia?

Answer 8

Delivery is the ultimate treatment
Betamethasone can be given if preterm
MgSO4 for seizure prophylaxis
If severe (BP >160/110) then labetalol or hydralazine

Question 9

What can patients with history of preeclampsia be given prior to future pregnancies?

Answer 9

low dose ASA

Question 10

What is eclampsia?

Answer 10

grand mal seizures in preeclamptic patients

Question 11

What is management of eclampsia?

Answer 11

ABCs
lower BP with hydralazine
MgSO4

Question 12

What can be given in case of MgSO4 overdose?

Answer 12

IV Ca gluconate