Hypertensive Disorders (7)

Question 1

What are the Maternal risks of HTN?

Answer 1

MI, cardiac failure, CVA, renal failure, liver failure

Question 2

What are the fetal risks of HTN?

Answer 2

Growth restriction, preterm birth, stillbirth, neonatal death

Question 3

What’s defined as high blood pressure? When is tx initiated?

Answer 3

140/90 > mild HTN < 160/10

Question 4

What is gestational HTN vs Chronic?

Answer 4

Chronic onset: before or recognized during first half of preg

gestational: onset after 20w gestation

Question 5

How many pregnancies does preeclampsia complicate? How is it diagnosed?

Answer 5

5-7%
Dg: HTN, proteinuria, edema (not used for diagnosis)
Sxs: blurred vision, HA

Question 6

What are the risk factors for preeclampsia?

Answer 6

Really young or really old pregnant women (biggest risk)
Primigravid
Hydatiform mole
DM
Chronic HTN
Renal dx
Anti-phospholipis syndrome
H/O preeclampsia

Question 7

What occurs in the brain, heart, lungs, liver, kidneys, and eyes in preeclampsia?

Answer 7

Brain: cerebral edema, micro-infarcts, fibrinoid necrosis
Heart: third spacing leading to reduced circulating blood volume
Lungs: non-cardiogenic pulmonary edema
Liver: stretching of glisson’s capsule (RUQ pain)
Kidneys: swelling, narrowing of capillary lumen
Eyes: retinal vasospasm and edema

Question 8

Mild (preeclampsia w/o severe features) vs Severe (preeclampsia w/ severe features:

Answer 8

Mild (most asx): BP 140/90 < mild < 160/110, 300mg/24h > proteinuria < 5g
Severe (sxs): BP > 160/110, 5g/24h or greater proteinuria or 3+ protein on two random urine dips 4 hours apart, oliguria (<500mL of urine in 24h), all the previously stated sxs of the organs

Question 9

What’s found on PE in someone with suspected preeclampsia? Lab findings?

Answer 9

Brisk reflexes, clonus (dorsiflex foot w/ response), edema

Inc: hematocrit, lactate dehydrogenase, AST/ALT (transaminases), uric acid

Thrombocytopenia (low platelets)

Question 10

Management of preeclampsia includes?

Answer 10

If less than 37w gestation, BED REST

• twice weekly antepartum testing
• fetal growth US every 3-4 weeks
• office visits and lab evals
• hospitalization (unlikely)

Between 37-40w: cervix-induction (if favorable)
- unfavorable? Use ripening agent (Dinoprostone)

Question 11

Severe preeclampsia management?

Answer 11

Pt must be hospitalized

HTN managed w/: Hydralizine, Labetalol, Nifedipine

Question 12

Is vaginal delivery preferred in preeclampsia pts?

Answer 12

Yes

Question 13

When is MgSO4 used in preeclampsia? How’s it administered? What must be monitored? What does high levels result in? What’s used in the case of high levels as antidote?

Answer 13

For severe cases

IV

Urine output and reflexes

Loss of patellar reflexes < respiratory paralysis < cardiac arrest

Calcium Gluconate

Question 14

What’s the first thing you do in a seizing pt? What drug is first-line tx?

Answer 14

Protect the airway (intubate)

MgSO4

Question 15

What is HELLP syndrome? What are the sxs? What does it demand in a pregnant lady? Can you have HELLP syndrome w/o preeclampsia?

Answer 15

Variant of preeclampsia that involves: hemolysis, elevated liver enzymes, low platelets

RUQ pain, epigastric pain, N/V, HTN and proteinuria variable

Immediate delivery

Negative

Question 16

How do you tx HELLP?

Answer 16

ASA prophylactically in pts w/ risk factors

Delivering child is only cure