hypertension in pregnancy Flashcards
what is hypertension defined as?
> /= 140/90 on at least 2 readings at least 4-6 hours apart
what is the number one risk of maternal and fetal morbidity and mortality?
hypertension
gestational htn and preeclampsia have a higher risk of what later in life?
heart disease
what is a risk factor for future cardiovascular and metabolic disorders in mothers?
preeclampsia
what are 5 high risk factors for preeclampsia?
- chronic htn
- ckd
- htn in previous pregnancy
- dm (1 and 2)
- autoimmune diseases
what are 5 moderate risk factors to preeclampsia?
- age >40
- first pregnancy
- multi-gestational pregnancy
- bmi >35
- family history of preeclampsia
what is the presentation of preeclampsia?
typically asymptomatic
what are 2 standard screenings for preeclampsia?
- BP screen
- Urinalysis standard
what are 5 “hidden” signs of preeclampsia?
- headache
- change in vision
- rapid weight gain
- edema
- abdominal pain
what is the only true cure of preeclampsia?
delivery
what are the 2 diagnostic criteria of preeclampsia?
- blood pressure
- proteinuria
what is diagnostic for proteinuria in preeclampsia?
> /= 300 mg per 24 hour urine collection
what is not a diagnostic tool for proteinuria in preeclampsia?
dip stick reading of 1+
when may delivery be indicated in a patient with preeclampsia?
if preeclampsia is uncontrolled for 24-48 hours
what are 6 severe preeclampsia symptoms?
- htn (>160 systolic, >110 diastolic)
- thrombocytopenia
- impaired liver function
- renal insufficiency
- pulmonary edema
- visual disturbance
what are 2 things that are used for prevention of preeclampsia?
- aspirin or LMWH
- calcium
what are 4 non pharm treatments for htn and preeclampsia?
- modified bed rest
- sodium restriction
- frequent fetal monitoring
- daily bp monitoring
when is treatment for htn recommended?
- chronic htn with persistent readings over 160/105
- severe htn with readings over 160/100 mmhg
what are 3 medications that acn be used to treat the htn?
- methyldopa
- nifedipine
- labetolol
what drug used for htn is an alpha 2 agonist?
methyldopa
what are the starting doses for nifedipine?
30-60 mg once or twice daily
what drug used for htn is a alpha/beta blocker
labetolol
what is the doc to treat the htn?
labetolol
when should you avoid the use of labetolol?
in pts with copd and asthma
what are 3 SE seen with nifedipine?
- flushing
- headache
- edema
what are 4 treatments that are not recommended?
- hydralazine
- ACEi/ARBs
- metoprolol/atenolol
- diuretics
why is hydralazine not recommended?
fetal heart abnormailities
why are ACEi/ARBs not recommended?
they are fetotoxic
why are diuretics not recommended?
affects uterine blood flow
why is metoprolol/atenolol not recommended?
risk of intrauterine growth restriction
what is eclampsia?
preeclampsia with seizures
when is eclampsia the most common?
in the 3rd trimester or within 48 hours of delivery
what is used for eclampsia prophylaxis?
magnesium sulfate
what are 4 ADRs that are seen with magnesium sulfate?
- confusion
- somnolence
- respiratory depression
- cardiac arrest
what is considered a premature delivery?
birth prior to 36.6 weeks
what is considered full term?
40 weeks or 37 if possible
what are 2 treatments for premature prophylaxis?
- betamethasone
- dexamethasone
when can you give premature prophylaxis?
gestational age 24-34 weeks and at risk of delivering within 7 days
when is treatment for BP after delivery recommended?
> 150/110 mmHg
if hydralazine or thiazides were given prior to birth what should be done?
a CBC in neonate because of reported cases of thrombocytopenia
