Hypertension in Pregnancy Lecture Powerpoint Flashcards
Most common medical risk factor in prenancy
Hypertension
Deadly triad of maternal mortality
- hemorrhage
- infection
- hypertension (most common)
Super imposed pre-eclampsia
chronic hypertension on top of pre-eclampsia, new onset proteinuria >300mg/24 hr and no proteinuria before 20 weeks, sudden increase in BP, proteinuria or drop in platelets in women with hypertension and proteinuria before 20 weeks
Gestational vs chronic hypertension
Gestational sees BP elevation after 20 weeks of pregnancy, chronic begins before
Pre-eclampsia definition
Disease only occurring in pregnancy with BP >140/90 mmhg after 20 weeks of gestation and proteinuria 300mg/24 hr or +1 on urine dipstick, increased in certainty with supplemental findings such as elevated creatinine, platelets, elevated ALT or AST, persistent headache, or persistent epigastric pain
Eclampsia definition
Meets criteria for pre-eclampsia but also has seizures that cannot be attributed to other causes (difficult to differentiate in epileptics), sees rapid increase in BP followed by convulsions or coma usually preceded by unrelenting severe headache
Chronic hypertension defiition
BP >= 140/90 before pregnancy or diagnosed before 20 weeks, persists long after pregnancy
Gestational hypertension most often affects __ women, chronic increases with ___
nulliparous, age
HELLP syndrome
Syndrome that occurs with pre-eclampsia characterized by hemolysis, elevated liver enzymes (doubled normal), and low platelet count (<100,000)
Eclampsia risk factors (7)
- primigravid status
- family history
- previous episode of pre or eclampsia
- new paternity
- BMI elevation
- extremes of maternal age
- preexisting disease
- twins increased risk
Pathogenesis of eclampsia
- arterial vasospasm causing leaking of fluid from capillaries and third spacing
- this reduces renal perfusion and glomerular filtration, with serum uric acid being elevated, liver injury or rupture, placental intrauterine growth restriction or abruption, edema, thrombocytopenia*****
- retinal artery vasospasm causes visual disturbances
- multifocal petechial hemorrhages at gray mater white matter junction, edema, thrombosis, and gross hemorrhage of the brain occurs
Plausible causes of eclampsia
- abnormal trophoblastic invasion of uterine vessels (incomplete trophoblastic invasion, decidual vessels but not myometrial vessels, amount of abnormal invasion correlated with severity of hypertension)
- dietary (all BS)
- Genetics (theorized autosomal recessive inheritance)
Prediction of eclampsia
No screening tests that are reliable, valid, or economic
Prevention of eclampsia
-low dose aspirin may be helpful
Lab eval for eclampsia (3)
- 24 hr urine protein
- CBC for thrombocytopenia
- urinalysis for proteinuria
