Hypertensive disorders Flashcards
Risk factors of hypertension in context of obs x6
Nulliparity
Preexisting DM
Preexisting HTN
Age <20 or >35
Gestational diabetes
Multiple pregnancy
5 classes of HTN in pregnant women
Eclampsia
Preeclampsia
Gestational HTN
Chronic HTN
Chronic HTN with superimposed preeclampsia
When can chronic HTN be detected x3
- Detected before pregnancy
- Persists after 12 weeks postnatal
- Detected in first 20 weeks of pregnancy
Causes of chronic HTN x5
SLE
Diabetic nephropathy
Diabetes mellitus
Renal artery stenosis
Pheochromocytoma
Management of chronic hypertension x3
First line- methyldopa/nifedipine
Second class- hydralazine
Risk factors of developing superimposed preeclampsia x6
Preexisting diabetes
Renal disease
Maternal age >40
Previous preeclampsia
Multiple pregnancy
Pre pregnancy BMI>35
Why avoid NSAIDs in postpartum women with chronic HTN
NSAIDs promote salt and water retention which results in exacerbated HTN and worsening kidney function
Pharmacotherapy target in chronic HTN x2
<150/100 in uncomplicated BP
< 140/90 if there is target organ damage
How to monitor patients with gestational HTN x3
- BP checks once/twice a week
- Weekly measurements of proteins and liver enzymes
- Monitor fetal growth
What features elevates gestational HTN to preeclampsia x3
Proteinuria
Thrombocytopenia
Elevated liver enzymes
#HELLP syndrome
When to deliver in gestational HTN w/o complications
39+6 weeks
Risks or complications caused by pregnancies of women with Severe GDM x3
Preterm delivery
Small for GA
Abruption of placenta
Define preeclampsia
HTN >140/110 appearing after 20 weeks GA with proteinuria 2+ and signs of potential organ damage
Morphological changes of placentas affected by preeclampsia x2
Areas of necrosis
Basal hematomas
Risk factors of preeclampsia x5
Family history of preeclampsia
BMI>35
Multiple pregnancies
First pregnancy
Preexisting renal D, DM, HTN
Describe two things that occur during abnormal placentation
- Failure of trophoblast to invade the myometrial tissue containing spiral arterioles
- Failure of spiral arterioles to become wide bore, low resistance and high capacity vessels
Signs seen on examination of a patient with preeclampsia x5
RUQ tenderness
Papilloedema
Facial edema
Poor urine output
Hyperreflexia and clonus
Fetal complications of preeclampsia x5
HIE
Oligohydramnios
Prematurity
Early fetal death
Acute and chronic uteroplacental insufficiency
Biochemistry results in preeclampsia x5
Low Hb
High Hct
Low platelets
ALT, AST > x2
Elevated creatinine
Pharmacological management of preeclampsia x2 and BP target
Oral nifedipine
IV hydralazine
Target < 160/85
Seizure prophylaxis in preeclampsia
Magnesium sulphate
What is used to counteract magnesium toxicity
Calcium gluconate
Indications of delivering at 34weeks GA in preeclampsia x4
Pulmonary edema
Progressive thrombocytopenia
Progressive elevated liver enzymes
Repeated high BPs on maintenance treatment
Define preeclampsia superimposed on chronic HTN
Development of proteinuria and significant end organ dysfunction after 20weeks GA in a woman with chronic hypertension
What is preeclampsia with severe feature x5
Thrombocytopenia
Pulmonary edema
Elevated liver transaminases
New onset or worsening renal insufficiency
Severe BPs despite escalated anti HTN therapy
Define eclampsia
It is the development of grand mal seizures in a woman with preeclampsia in the absence of other neurologic conditions
Clinical features of eclampsia x5
Seizures
Headache- frontal, occipital, thunderclap
Cortical blindness
Blurred vision
Diplopia
RUQ/epigastric pain
Treatment goals of eclampsia x4
Treatment of severe HTN
Prevent recurrent seizures
Evaluation of prompt delivery
Prevention of maternal hypoxia and trauma
Management of HTN in eclampsia in emergencies (1) and non emergencies (2)
Hydralazine
Methyldopa
Nifedipine
Signs of magnesium sulphate toxicity x4
Cardiac arrest
Muscle paralysis
Respiratory depression
Loss of deep tendon reflexes
4 factors to consider when determining mode of delivery in eclampsia
GA
Fetal position
Cervical status
Labor status
Indications of delivery in patients with HELLP syndrome x2
GA> 34 weeks
Deteriorating maternal or fetal status
Maternal complications of HELLP Syndrome x4
DIC
Stroke
Pulmonary edema
Abruptio placentae
What prophylaxis is given to women at risk of preeclampsia
Low dose aspirin which prevents formation of substances that cause inflammation involved in abnormal placentation
Aspirin promotes blood flow
Management of preeclampsia with severe features x4
IV hydralazine
MgSO4 prophylaxis
Antenatal corticosteroid therapy
Delivery after stabilization
