Hypertension Disorders of Pregnancy Flashcards
What are the 2 criteria that needs to be met to define preeclampsia?
- hypertension
- proteinuria
*edema no longer part of diagnosis
What are the 3 criteria that can be used to diagnose proteinuria for preeclampsia?
- protein/creatinine ratio of >0.3 mg/dL
- 300 mg/liter in a 24hr collection
- 1+ or greater on a dipstick
A patient presents with a BP of 160/115. She has noticed a low urine output. Associated symptoms include headaches, visual disturbances, and epigastric pain. Labs demonstrate a 2 fold increase in ALT/AST. What is the diagnosis?
- severe preeclampsia
What are the 2 most common risk factors for preeclampsia?
- nulliparity
- age under 20 and over 35
*most common risk factors Dr. Marino sees
An abnormal PGI2/TXA2 ratio is associated with this condition.
- preeclampsia
What medication do we give to try and prevent preeclampsia?
- low dose aspirin (81 mg)
In order to make the diagnosis of preeclampsia you need to know these 3 things.
- normal physiologic changes in pregnancy
- baseline BP
- baseline proteinuria in someone at risk
T/F: There is no effective method for identifying women at risk for preeclampsia.
True
What is the ultimate treatment for preeclampsia?
delivery of baby
What are the 2 main treatment goals of preeclampsia?
- prevention of seizures
- treatment of HBP
What medication is used to prevent seizures in preeclampsia?
- Magnesium Sulfate
Magnesium is excreted by what organ?
kidneys
*so if patient has impaired kidney function need to be cautious in administration
If a mother has severe preeclampsia that is life-threatening by what week can they have a pre-term delivery?
by 34 weeks
Recurrence rate of severe preeclampsia in subsequent pregnancies is greater in what situation?
- if it occurs early in gestation
What is the most common type of hypertension in pregnancy?
primary hypertension (90%)
How is chronic hypertension defined?
hypertension diagnosed before 20th week of gestation
What are the 2 main risks for the fetus with maternal hypertension?
- fetal growth restriction
- oligohydramnios
What labs do you want to order for a pregnant female who presents with chronic hypertension to help differentiate from preeclampsia?
- 24 hr urine collection, BUN, creatinine, CrCl
What drug is given for chronic hypertension to prevent preeclampsia?
low dose aspirin
This is one of the oldest antihypertensives that reduces systemic vascular resistance and has a good safety profile.
Aldomet (Alphametyldopa)
What are the 2 most commonly used antihypertensives for pregnancy?
- Labetalol (BB)
- Nifedipine (CCB)
What beta-blocker also has some alpha receptor activity?
labetalol
These antihypertensive drugs are contraindicated after the first trimester.
- ACE inhibitors
How is gestational hypertension defined?
hypertension diagnosed after 20 weeks of gestation that returns to normal 6 weeks postpartum
What is the purpose in delivering early at 37 weeks in mothers with gestational hypertension?
prevent preeclampsia
What are the 3 factors that makes up HELLP syndrome?
- hemolytic anemia
- elevated liver function
- low platelets
20% of women with preeclampsia present with this syndrome.
HEELP syndrome
This condition usually happens in the 2nd trimester and consists of neurological symptoms, fever, and more renal involvement.
a. HELLP
b. TTP
c. HUS
d. AFLP
b. TTP
This condition usually happens in the younger age group. It is classified as a post-partum disease and the hallmark sign is severe renal dysfunction.
a. HELLP
b. TTP
c. HUS
d. AFLP
c. HUS
This condition is defined by DIC, hypoglycemia, low fibrinogen, and renal failure.
a. HELLP
b. TTP
c. HUS
d. AFLP
d. AFLP (Acute Fatty Liver of Pregnancy)
This is defined as new onset of proteinuria in women with chronic hypertension.
superimposed preeclampsia
This is defined as the presence of grand mal seizure in patient with preeclampsia
eclampsia
most severe form of preeclampsia
What is the medical treatment of eclampsia?
Magnesium Sulfate (MgSO4)
