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ObGyn Lecture > Hypertension in Pregnancy > Flashcards

Hypertension in Pregnancy Flashcards

1
Q

What is chronic HTN?

A

HTN present before pregnancy or before 20th weeks or persists beyond 12 weeks post-partum

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2
Q

What is mild HTN?

A

140-159 / 90-109

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3
Q

What is gestational HTN?

A

Develops after the 20th week of pregnancy in the absence of proteinuria and resolves after delivery

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4
Q

What is severe HTN?

A

> 160/ >110

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5
Q

What is HTN with proteinuria after the 20th weeks of pregnancy?

A

Preeclampsia (“toxemia”)

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6
Q

What is the additional presence of seizures in a woman w/ pre-eclampsia w/ out hx of neurologic disease?

A

Eclampsia

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7
Q

what is HELLP Syndrome?

A

Presence of hemolysis, elevated liver enzymes, low platelet count

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8
Q

What is the predominant pathophys finding in preeclampsia and gestational HTN?

A

Maternal vasospasm

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9
Q

What happens to the renal system with HTN in pregnancy?

A

decrease GFR and proteinuria
decreased uric acid filtration
oliguria

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10
Q

What can happen with the fetus with maternal HTN?

A

Decreased placental perfusion
oligohydramnios (too little amniotic fluid)
IUGR
fetal hypoxia & malnutrition

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11
Q

What will patients with preeclampsia complain about?

A 
Visual disturbance (scotomata) 
headache
RUQ/ epigastric pain
Peripheral edema
rapid weight gain
oliguria
SOB
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12
Q

What will a patient with preeclampsia look like?

A

Puffy faced
edematous
tenderness over liver
hyper-reflexia

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13
Q

What labs do you want with precclampsia?

A

CBC, LFT
urinalysis (>0.3 grams protein in 24h specimen)
liver enzymes (elevated)

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14
Q

After taking a BP sitting up, what way should you take the BP in a pregnant women.

A

Lay in left lateral position, can decrease BP

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15
Q

In severe preeclampsia what will the proteinuria be?

A

3+ or more than x2 on dipstick

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16
Q

What are some risk factors for preeclampsia?

A 
DM
chronic HTN or prior preeclampsia
>35 years old
African American
obesity
autoimmune dz
pre-gestational DM
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17
Q

When do most cases of eclampsia occur?

A

within 24 hours of delivery but may occur 2-10 days AFTER

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18
Q

what is the criteria for HELLP syndrome?

A

Microangiopathic hemolysis, thrombocytopenia, hepatocellular dysfunction

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19
Q

When do you give meds to treat HTN in pregnancy?

A

Give meds when systolic is 150-160 or diastolic 100-110.

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20
Q

Can ACE inhibitors and ARB’s be given to pregnant women?

A

No due to fetal malformations

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21
Q

What is the treatment for mild preeclampsia?

A

Rest, frequent monitoring, deliver in timely manner

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22
Q

How do you treat severe precclampsia?

A

hospitalization
daily lab tests/ fetal surveillance
Give magnesium sulfate (prevent seizure)
give antihypertensive treatment

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23
Q

How do you manage an ecclamptic seizure?

A

make sure they don’t injure themselves
give magnesium sulfate to prevent further seizures
delivery once stable

24
Q

What are some symptoms of HELLP syndrome?

A

vague, but N/V and viral-like
require cardiac stabilization and delivery
may need platelet transfusion (below 20,000)

25
Q

What is where the placenta partially or completely covers the cervical os?

A

Placenta previa

26
Q

What is a partial placenta previa?

A

Overlies the internal os. Often resolves by weeks 32-35

27
Q

What is a complete placenta previa?

A

Covers the entire internal os.

Rarely resolves spontaneous

28
Q

What is a “low-lying” placenta previa?

A

extends into lower uterine segment but doesn’t reach internal os. Usually reviews by 32-35 weeks.

29
Q

What is the clinical feature of placenta previa?

A

painless bleeding

30
Q

Should you check the cervix at random?

A

No- must know where the placenta is first!

31
Q

What are some risk factors for placenta previa

A

advanced age
smoking
cocaine use
high parity

32
Q

How is a placenta previa baby be delivered?

A

Cesarean section

33
Q

What is where placental tissue extends into the superficial layer of the myometrium?

A

Placenta accreta

34
Q

What is where the placenta extends further into the myometrium?

A

Placenta increta

35
Q

What is where the placenta extends completely through the myometrium to the serosa and sometimes to adjacent organs.

A

Placenta percreta

36
Q

What is where there is a separation of a normally implanted placenta after the 20th week of gestation and before birth?

A

Placenta abruption

37
Q

What is a complete placenta abruption?

A

entire placenta separates from teh uterine wall

38
Q

What is a partial placental abruption?

A

Part of the placenta separates from the uterine wall

39
Q

What is where the placenta separation is limited to the edge of the placenta?

A

Marginal abruption

40
Q

What is where blood is trapped behind the placenta and is unable to exit?

A

concealed hemorrhage

41
Q

what is the main clinical feature of placental abruption?

A

painful vaginal bleeding and tender uterus on palpation

42
Q

What is where blood penetrates the uterus so that it turns the serosa blue or purple in color. This is a complication of placental abruption.

A

Couvelaire uterus

43
Q

With an _____ in AFP, it is more likely to have placental abruption.

A

increase

44
Q

What is the passage of fetal blood vessels over the internal os below the presenting part of the fetus?

A

Vasa previa

45
Q

WHat is where there is spontaneous and complete transection of the uterus from the endometrium to the serosa?

A

Uterine rupture

46
Q

What happens with uterine rupture?

A

Baby expelled into abdomen

immediate C-section needed

47
Q

Who is at most risk for uterine rupture?

A

Those attempting to deliver vaginally after C-section

48
Q

What is the most significant risk of pre term birth (PTB)?

A

a hx of preterm birth

49
Q

What is a pre-term birth?

A

Occurs before 37 weeks

50
Q

What is considered very PTB (pre-term birth)?

A

<32 weeks

51
Q

How long is a normal cervix?

A

4 cm (gets shorter as you go into labor)

52
Q

What SROM?

A

Spontaneous rupture of membranes

contracting then water breaks

53
Q

What is PROM?

A

premature rupture of membranes

didn’t start contracting and water breaks

54
Q

What is PPROM?

A

Pre-term premature rupture of membranes

rupture of membranes before 37 weeks

55
Q

How can you tell if there is amniotic fluid leakage (not just pee)?

A

See if it turns the alkaline paper blue
Have them cough and see if you see it (speculum exam)
get a sample of fluid onto slide and will see a fern pattern

ObGyn Lecture (21 decks)

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