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ObGyn > Hypertensive disorders > Flashcards

Hypertensive disorders Flashcards

1
Q

Risk factors of hypertension in context of obs x6

A

Nulliparity
Preexisting DM
Preexisting HTN
Age <20 or >35
Gestational diabetes
Multiple pregnancy

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2
Q

5 classes of HTN in pregnant women

A

Eclampsia
Preeclampsia
Gestational HTN
Chronic HTN
Chronic HTN with superimposed preeclampsia

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3
Q

When can chronic HTN be detected x3

A
  1. Detected before pregnancy
  2. Persists after 12 weeks postnatal
  3. Detected in first 20 weeks of pregnancy
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4
Q

Causes of chronic HTN x5

A

SLE
Diabetic nephropathy
Diabetes mellitus
Renal artery stenosis
Pheochromocytoma

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5
Q

Management of chronic hypertension x3

A

First line- methyldopa/nifedipine
Second class- hydralazine

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6
Q

Risk factors of developing superimposed preeclampsia x6

A

Preexisting diabetes
Renal disease
Maternal age >40
Previous preeclampsia
Multiple pregnancy
Pre pregnancy BMI>35

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7
Q

Why avoid NSAIDs in postpartum women with chronic HTN

A

NSAIDs promote salt and water retention which results in exacerbated HTN and worsening kidney function

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8
Q

Pharmacotherapy target in chronic HTN x2

A

<150/100 in uncomplicated BP
< 140/90 if there is target organ damage

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9
Q

How to monitor patients with gestational HTN x3

A
  1. BP checks once/twice a week
  2. Weekly measurements of proteins and liver enzymes
  3. Monitor fetal growth
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10
Q

What features elevates gestational HTN to preeclampsia x3

A

Proteinuria
Thrombocytopenia
Elevated liver enzymes
#HELLP syndrome

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10
Q

When to deliver in gestational HTN w/o complications

A

39+6 weeks

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11
Q

Risks or complications caused by pregnancies of women with Severe GDM x3

A

Preterm delivery
Small for GA
Abruption of placenta

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12
Q

Define preeclampsia

A

HTN >140/110 appearing after 20 weeks GA with proteinuria 2+ and signs of potential organ damage

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13
Q

Morphological changes of placentas affected by preeclampsia x2

A

Areas of necrosis
Basal hematomas

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14
Q

Risk factors of preeclampsia x5

A

Family history of preeclampsia
BMI>35
Multiple pregnancies
First pregnancy
Preexisting renal D, DM, HTN

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15
Q

Describe two things that occur during abnormal placentation

A
  1. Failure of trophoblast to invade the myometrial tissue containing spiral arterioles
  2. Failure of spiral arterioles to become wide bore, low resistance and high capacity vessels
16
Q
A
16
Q

Signs seen on examination of a patient with preeclampsia x5

A

RUQ tenderness
Papilloedema
Facial edema
Poor urine output
Hyperreflexia and clonus

17
Q

Fetal complications of preeclampsia x5

A

HIE
Oligohydramnios
Prematurity
Early fetal death
Acute and chronic uteroplacental insufficiency

18
Q

Biochemistry results in preeclampsia x5

A

Low Hb
High Hct
Low platelets
ALT, AST > x2
Elevated creatinine

19
Q

Pharmacological management of preeclampsia x2 and BP target

A

Oral nifedipine
IV hydralazine
Target < 160/85

20
Q

Seizure prophylaxis in preeclampsia

A

Magnesium sulphate

21
Q

What is used to counteract magnesium toxicity

A

Calcium gluconate

22
Q

Indications of delivering at 34weeks GA in preeclampsia x4

A

Pulmonary edema
Progressive thrombocytopenia
Progressive elevated liver enzymes
Repeated high BPs on maintenance treatment

23
Q

Define preeclampsia superimposed on chronic HTN

A

Development of proteinuria and significant end organ dysfunction after 20weeks GA in a woman with chronic hypertension

24
Q

What is preeclampsia with severe feature x5

A

Thrombocytopenia
Pulmonary edema
Elevated liver transaminases
New onset or worsening renal insufficiency
Severe BPs despite escalated anti HTN therapy

25
Q

Define eclampsia

A

It is the development of grand mal seizures in a woman with preeclampsia in the absence of other neurologic conditions

26
Q

Clinical features of eclampsia x5

A

Seizures
Headache- frontal, occipital, thunderclap
Cortical blindness
Blurred vision
Diplopia
RUQ/epigastric pain

27
Q

Treatment goals of eclampsia x4

A

Treatment of severe HTN
Prevent recurrent seizures
Evaluation of prompt delivery
Prevention of maternal hypoxia and trauma

28
Q

Management of HTN in eclampsia in emergencies (1) and non emergencies (2)

A

Hydralazine

Methyldopa
Nifedipine

29
Q

Signs of magnesium sulphate toxicity x4

A

Cardiac arrest
Muscle paralysis
Respiratory depression
Loss of deep tendon reflexes

30
Q

4 factors to consider when determining mode of delivery in eclampsia

A

GA
Fetal position
Cervical status
Labor status

31
Q

Indications of delivery in patients with HELLP syndrome x2

A

GA> 34 weeks
Deteriorating maternal or fetal status

32
Q

Maternal complications of HELLP Syndrome x4

A

DIC
Stroke
Pulmonary edema
Abruptio placentae

33
Q

What prophylaxis is given to women at risk of preeclampsia

A

Low dose aspirin which prevents formation of substances that cause inflammation involved in abnormal placentation
Aspirin promotes blood flow

34
Q

Management of preeclampsia with severe features x4

A

IV hydralazine
MgSO4 prophylaxis
Antenatal corticosteroid therapy
Delivery after stabilization

ObGyn (34 decks)

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