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Hypertensive Disorders Flashcards

1
Q

Deadly triad of Pregnancy

A
  1. Hypertensive Disorders (16%)
  2. Hemorrhage (13%)
  3. Infection (Abortion- 8%; Sepsis -2%)
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2
Q

How much does hypertensive disorders complicate pregnancies?

A

5-10%

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3
Q

Describe Gestational HTN

A

BP >140/90 AFTER 20 weeks AOG
(-)proteinuria
Resolves 12 weeks postpartum

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4
Q

Proteinuria in pregnancy

A

> 300mg/24hr
Protein:Creatinine ratio >0.3
Dipstick 1+ persistent

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5
Q

Describe preeclampsia and eclampsia syndrome

A

Both occurs BP >140/90 AFTER 20 weeks AOG in previously normotensive woman
(+) Proteinuria

*Eclampsia (+) seizure

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6
Q

Other labs that you can consider to identify preeclampsia and eclampsia syndrome

A
  • CBC with PC = Thrombocytopenia (<100,000/uL)
  • UA with stat albumin; BUN; Cr = Renal insufficiency (Cr >1.1dL or 2x)
  • AST & ALT = Liver involvement (2x)
  • Cerebral symptoms (Headache, Visual Disturbances, Convulsions)
  • Pulmonary Edema
  • Electrolytes
  • LDH (>600 IU/L) = Assess hemolysis in HELLP syndrome
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7
Q

Describe Chronic HTN

A

(+) Hx of HTN BEFORE 20 weeks AOG

(+) HTN AFTER 12 weeks pp

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8
Q

Describe Preeclampsia superimposed on Chronic HTN

A

AFTER 20 weeks AOG…
(+) Proteinuria
Sudden increase in BP/Proteinuria after 20 weeks
(+)Thrombocytopenia

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9
Q

BP during trimesters

A

1st: Increased
2nd to early 3rd: Decreases
Late 3rd: Normal

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10
Q

Pathology of preeclampsia

A

Systematic endothelial leak

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11
Q

Risk factors of Preeclampsia

A
  • Young and nulliparous
  • Genetic Predisposition
  • Maternal Weight, Obesity, Metabolic Syndrome
  • Multifetal gestation
  • Hyperhomocysteinemia
  • Hx of preeclampsia
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12
Q

Management for Pre-eclampsia

A

1st line: Metyldopa 500mg PO q6-8h (max: 3g/day)

2nd line: Hydrazaline 25mg PO q6-12h

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13
Q

Complications of Pre-eclampsia

A

Abruptio placenta
End organ damage
Intrauterine Growth Restriction (IUGR)
Increased risk for CS

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14
Q

Emergency Medicine for Pre-eclampsia

A

Hydralazine 5mg IV PRN q20mins for BP >160/100 (max: 30mg “5-5-5-10-10”)

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15
Q

How does Magnesium Sulfate helps in Pre-eclampsia?

A

Seizure protection; Protects Infant’s Neurological development

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16
Q

How to use Magnesium Sulfate for Pre-eclampsia?

A
  1. Give IV sedation (Promethazine 25mg)
  2. Insert foley catheter to check U/O if >30cc/hr
    Loading dose: 4g Slow Intravenous Push (SIVP), 5mg IM each buttocks (Total: 14mg)
    Maintenance dose: 5mg IM alternating buttocks q6h x 4 doses (total of 20mg within 24 hours)
17
Q

Why should you check U/O before administering MgSO4?

A

Because it’s renally cleared

18
Q

Therapeutic dose of MgSO4

19
Q

Antidote for MgSO4 toxicity

A

Calcium Gluconate 1g SIVP

20
Q

Possible occurrences during MgSO4 toxicity

A

8-10 mEq/L = Hyporeflexia, Areflexic @ 10
10-12 = Respiratory depression, arrest @ 12
>12 = Altered Consciousness

21
Q

Can you use aspirin to prevent progression to superimposed pre-eclampia?

22
Q

Epidemiology of Eclampsia

A

-10% of cases occurs before overt proteinuria is detected
-Can occur anytime during pregnancy and pp
1st: assoc with molar/hydropic degeneration of placenta
3rd: Most common
PP: within 48hrs

23
Q

Management of Eclampsia

A
  1. Give MgSO4
  2. Control severe HTN (IV Hydralazine/Nicardipine)
  3. Delivery
24
Q

Goal BP in management of Eclampsia

A

140/90 to 155/105

25
Q

What does HELLP syndrome means?

A

Hemolysis
Elevated Liver Enzymes
Low PC

26
Q

Identifiers and classification of HELLP Syndrome using the Tennessee Criteria?

A

LDH, PC, AST/ALT

Partial 2/3
Full 3/3

27
Q

Identifiers and classification of HELLP Syndrome using the Mississippi Criteria?

A

PC AST/ALT LDH
I <50 >/=70 >/= 600IU/L
II 50-100 >/=70 >/= 600IU/L
III 100-150 >/= 40 >/= 600IU/L

28
Q

Complication of HELLP Syndrome

A 
Eclampsia (6%)
Abruptio placenta (10%)
Pulmonary Edema (10%)
AKI (5%)
Subcapsular liver hematoma (1.6%)
Stroke, Coagulopathy, ARDS, Sepsis
29
Q

21 y/o G1P0 pregnancy uterine 17 weeks by early ultrasound came in for prenatal check-up. BP revealed 150/90. How will you diagnose this case given these data?

a. Preclampsia with severe features
b. Preeclampsia with non-severe features
c. Chronic hypertension
d. Gestational hypertension

30
Q

19 y/o G1P0 pregnancy uterine 36 weeks by LMP came in due to labor pains. BP revealed 150/100. No other associated signs/symptoms such as headache, epigastric pain, etc. Urinalysis revealed proteinuria of 1+. How will you diagnose this case?

a. Preeclampsia with severe features
b. Preeclampsia with non-severe features
c. Chronic hypertension
d. Gestational hypertension

31
Q

23 y/o G1P0 pregnancy uterine 39 weeks age of gestation by LMP came in due to ruptured bag of water. BP revealed 160/110. No other associated signs/symptoms. Urinalysis revealed no proteinuria, platelet count of 150,000/uL. How will you diagnose this case?

a. Preeclampsia with severe features
b. Preeclampsia without severe features
c. Chronic hypertension
d. Gestational hypertension

32
Q

Risk factor for preeclampsia, except?

a. Young age
b. Nulliparity
c. Smoking
d. Male fetus

33
Q

Hallmark for eclampsia *

a. Thrombocytopenia
b. Hemoconcentration
c. Proteinuria
d. Seizures

34
Q

Severe preeclampsia is frequently accompanied by hemolysis, which manifests as follows, except: *

a. Decreased haptoglobin
b. Decreased hematocrit
c. Reticulocytosis
d. Elevated LDH

35
Q

Abnormal protein excretion is empirically defined as follows, except: *

a. Urine protein:creatinine ratio ≥0.3
b. 24-hour urine protein of more than 300mg
c. +2 proteinuria
d. 30 mg/dL urine protein

36
Q

Corticosteroid therapy for lung maturation and delivery after maternal stabilization is considered in the following cases, except: *

a. Fetal Demise
b. Eclampsia
c. Oligohydramnios
d. Uncontrolled hypertension
e. Disseminated Intravascular Coagulation (DIC)
f. Abruptio placenta

37
Q

BJ, 27 y/o G1P0 pregnancy uterine 33 6/7 weeks AOG came in due to blurring of vision. BP revealed 160/110. You are entertaining preeclampsia with severe features, hence you admitted the patient. After stabilizing the BP of the patient, you will perform the following, except:

a. Give magnesium sulfate to prevent seizure episodes
b. Give dexamethasone 6mg, every 12 hours, for 4 doses – beta BID
c. Insert indwelling foley catheter (IFC)
d. Daily CBC monitoring
e. Give magnesium sulfate for neuroprotection

38
Q

One day after admission, BJ developed abdominal pain which was sudden in onset (pain scale 7/10) associated with vaginal bleeding (2 adult diaper pads per day). BP was 180/120. PE revealed tenderness at the fundal area. Internal examination revealed soft and closed. What is your next step? *

a. Confirm fetal viability
b. Perform emergency cesarean section right away
c. Perform labor augementation
d. Perform labor induction

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