hypertension during pregnancy

Question 1

transitional (gestational) HTN

Answer 1

htn w/ no proteinuria after 20 wks gestation

resolves 12 wks postpartum

Question 2

s/sx of gest. htn

Answer 2

asx

Question 3

dx of gest htn

Answer 3

increased BP and NO proteinuria

Question 4

PP of gest htn

Answer 4

due to arteriolar vasoconstriction

Question 5

tx of gest htn

Answer 5

hydralazine, lebatalol, methyldopa

Question 6

preeclampsia

Answer 6

HTN. proteinuria, +/- edema after 20 wks

can occur up to 6 wks post partums

Question 7

what is the mc rf for preeclampsia?

Answer 7

nulliparity

Question 8

s/sx of preeclampsi

Answer 8

sx of htn: hx, blurry vision

fetal growth restriction

edema caused by proteinuria (decrease in oncotic pressure) but this is not needed for dx

Question 9

what is mild preeclampsia?

Answer 9

BP >/= 140/90 on 2 sep, occasions @ least 6 hrs apart (but not > 1 wk apart)
proteinuria= > 300 mg/24 hrs (or > 1+ on dipstick)

Question 10

what is severe preeclampsia?

Answer 10

BP > 160/110

sxs of htn
proteinuria: >5 g/24 hrs ( or > 3+ on urine dipstick)
oliguria
thrombocytopenia + DIC
HELLP syndrome: hemolytic anemia, elevated liver enzymes, low platelets)

Question 11

tx for mild preeclampsia

Answer 11

delivery is > 37 wks

conservative if < 34 wks–> daily weights, BP, dipstick
and steroids to mature lungs if < 34 wks and elective delivery is planned

Question 12

tx for severe preeclampsia

Answer 12

prompt delivery is only cure

+ hospitalization and magnesium sulfate to prevent eclampsia sz

• BP meds in acute severe HTN, may be started lower in some cases
• hydralazyine, labetalol, nifedipine

Question 13

eclampsia

Answer 13

-sz or coma in pts who meed preeclampsia criteria

Question 14

s/sx of eclampsia

Answer 14

abrupt tonic-clonic sz 1-2 min, postictal sate

+/- hA, visual changes, cardiorespiratory arrest

Question 15

dx of eclampsia

Answer 15

same as preeclampsia + sz

hyperreflexia

Question 16

tx of eclampsia

Answer 16

ABCDs first
-mg sulfate for sz

delivery when stable
BP meds

Question 17

what is 2cd line med for eclampsia sz if refractory to tx?

Answer 17

lorazepam

Question 18

chronic/pre-existing htn

Answer 18

htn before 20 wks gestation or before prego

persists > 6 wks post partum

Question 19

s/ sx of pre-exisiting htn

Answer 19

sx o f htn duh.

Question 20

dx of htn

Answer 20

mild: BP > 140-90 on two sep occasions

mod > 150/100

severe > 160/110

Question 21

what bp meds do you want to avoid in pregnancy?

Answer 21

ACEI and diuretics