Hypertension in Pregnancy Flashcards
What is chronic HTN?
HTN present before pregnancy or before 20th weeks or persists beyond 12 weeks post-partum
What is mild HTN?
140-159 / 90-109
What is gestational HTN?
Develops after the 20th week of pregnancy in the absence of proteinuria and resolves after delivery
What is severe HTN?
> 160/ >110
What is HTN with proteinuria after the 20th weeks of pregnancy?
Preeclampsia (“toxemia”)
What is the additional presence of seizures in a woman w/ pre-eclampsia w/ out hx of neurologic disease?
Eclampsia
what is HELLP Syndrome?
Presence of hemolysis, elevated liver enzymes, low platelet count
What is the predominant pathophys finding in preeclampsia and gestational HTN?
Maternal vasospasm
What happens to the renal system with HTN in pregnancy?
decrease GFR and proteinuria
decreased uric acid filtration
oliguria
What can happen with the fetus with maternal HTN?
Decreased placental perfusion
oligohydramnios (too little amniotic fluid)
IUGR
fetal hypoxia & malnutrition
What will patients with preeclampsia complain about?
Visual disturbance (scotomata) headache RUQ/ epigastric pain Peripheral edema rapid weight gain oliguria SOB
What will a patient with preeclampsia look like?
Puffy faced
edematous
tenderness over liver
hyper-reflexia
What labs do you want with precclampsia?
CBC, LFT
urinalysis (>0.3 grams protein in 24h specimen)
liver enzymes (elevated)
After taking a BP sitting up, what way should you take the BP in a pregnant women.
Lay in left lateral position, can decrease BP
In severe preeclampsia what will the proteinuria be?
3+ or more than x2 on dipstick
What are some risk factors for preeclampsia?
DM chronic HTN or prior preeclampsia >35 years old African American obesity autoimmune dz pre-gestational DM
When do most cases of eclampsia occur?
within 24 hours of delivery but may occur 2-10 days AFTER
what is the criteria for HELLP syndrome?
Microangiopathic hemolysis, thrombocytopenia, hepatocellular dysfunction
When do you give meds to treat HTN in pregnancy?
Give meds when systolic is 150-160 or diastolic 100-110.
Can ACE inhibitors and ARB’s be given to pregnant women?
No due to fetal malformations
What is the treatment for mild preeclampsia?
Rest, frequent monitoring, deliver in timely manner
How do you treat severe precclampsia?
hospitalization
daily lab tests/ fetal surveillance
Give magnesium sulfate (prevent seizure)
give antihypertensive treatment
How do you manage an ecclamptic seizure?
make sure they don’t injure themselves
give magnesium sulfate to prevent further seizures
delivery once stable
What are some symptoms of HELLP syndrome?
vague, but N/V and viral-like
require cardiac stabilization and delivery
may need platelet transfusion (below 20,000)
What is where the placenta partially or completely covers the cervical os?
Placenta previa
What is a partial placenta previa?
Overlies the internal os. Often resolves by weeks 32-35
What is a complete placenta previa?
Covers the entire internal os.
Rarely resolves spontaneous
What is a “low-lying” placenta previa?
extends into lower uterine segment but doesn’t reach internal os. Usually reviews by 32-35 weeks.
What is the clinical feature of placenta previa?
painless bleeding
Should you check the cervix at random?
No- must know where the placenta is first!
What are some risk factors for placenta previa
advanced age
smoking
cocaine use
high parity
How is a placenta previa baby be delivered?
Cesarean section
What is where placental tissue extends into the superficial layer of the myometrium?
Placenta accreta
What is where the placenta extends further into the myometrium?
Placenta increta
What is where the placenta extends completely through the myometrium to the serosa and sometimes to adjacent organs.
Placenta percreta
What is where there is a separation of a normally implanted placenta after the 20th week of gestation and before birth?
Placenta abruption
What is a complete placenta abruption?
entire placenta separates from teh uterine wall
What is a partial placental abruption?
Part of the placenta separates from the uterine wall
What is where the placenta separation is limited to the edge of the placenta?
Marginal abruption
What is where blood is trapped behind the placenta and is unable to exit?
concealed hemorrhage
what is the main clinical feature of placental abruption?
painful vaginal bleeding and tender uterus on palpation
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.
Couvelaire uterus
With an _____ in AFP, it is more likely to have placental abruption.
increase
What is the passage of fetal blood vessels over the internal os below the presenting part of the fetus?
Vasa previa
WHat is where there is spontaneous and complete transection of the uterus from the endometrium to the serosa?
Uterine rupture
What happens with uterine rupture?
Baby expelled into abdomen
immediate C-section needed
Who is at most risk for uterine rupture?
Those attempting to deliver vaginally after C-section
What is the most significant risk of pre term birth (PTB)?
a hx of preterm birth
What is a pre-term birth?
Occurs before 37 weeks
What is considered very PTB (pre-term birth)?
<32 weeks
How long is a normal cervix?
4 cm (gets shorter as you go into labor)
What SROM?
Spontaneous rupture of membranes
contracting then water breaks
What is PROM?
premature rupture of membranes
didn’t start contracting and water breaks
What is PPROM?
Pre-term premature rupture of membranes
rupture of membranes before 37 weeks
How can you tell if there is amniotic fluid leakage (not just pee)?
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
