Hypertension disorders in pregnancy

Question 1

List risk factors for preeclampsia.

Answer 1

• Nulliparity
• Multifetal gestations
• Preeclampsia in a previous pregnancy
• Chronic HTN
• Pregestational diabetes
• Gestational diabetes
• Thrombophilia
• Systemic lupus erythematosus
• Prepregnancy body mmass index greater than 30
• Antiphospholipid antibody syndrome
• Maternal age 35+
• Kidney disease
• Assisted reproductive technology
• OSA

Question 2

In the absence of proteinuria, pts should be dx with PEC if they present with what severe features?

Answer 2

• Thrombocytopenia (platelet count less than 100)
• Impaired liver function (elevated 2x upper limit of normal)
• Severe presistent RUQ or epigastric pain not accounted for by alternative dx
• Renal insufficiency (serum creat > 1.1mg/dL or doubling serum creatinine concentration in absence of toher renal disease)
• Pulmonary edema
• New-onset headache unresponsive to acetaminophen and not accoutned for by alternative dx

Question 3

gHTN definition

Answer 3

Systolic BP > 140 mmHg and/or diastolic BP 90 mmHg on 2 different occassions at least 4 hours apart.

Question 4

Definition of PEC

Answer 4

Severe range pressure
Systolic BP of 160 mmHg + or diastolic 110 mmHg

or 140/90 with ccompanying symptoms (proteinuria, thrombocytopenia, etc.)

Question 5

Proteinuria in pregnancy

Answer 5

• Defined as 300 mg/dL of protein or more in a 24 hr urine or protein to creatinine ratio of 0.30 or more
• Dipstick has high false-positive and false-negative test results

Question 6

Severe features of PEC

Answer 6

• Thrombocytopenia (< 100)
• Impaired liver function (elevated liver enzymes over 2x upper limit) and severe RUQ or epigastric pain unresponseive to medications and no other dx
• Renal insufficiency (serum creatinine > 1.1 mg/DL or doubling of creatinine concentration in the absence of other renal disease)
• Pulmonary edema
• New-onset headache unresponsive to medications (no alternative dx)
• Visual disturbances