Hypertensive Disorders Flashcards
(90 cards)
When does gestational hypertension begin?
What is the criteria?
How can this easily be confirmed?
In pregnancy after 20 weeks gestation
On 2 occasions at least 4 hours apart
Systolic OR diastolic pressure can be affected
If the BP falls back down after PG within 12 weeks
What is one reason why you may not even know when someone’s hypertension started and thus, you can’t accurately diagnosis if the hypertension is from PG or not?
If mom came in to the doctor and checks up later on in her PG rather than earlier so you don’t know when the HTN started
What is pre-eclampsia?
Similar to gestational hypertension. The BP will be hypertensive with the onset of pregnancy EXCEPT she will also have proteinuria.
It’s the next pitstop i guess.
What is hypertension for pregnancy?
When BP is 140/90 after 20 weeks but only ONE of these numbers has to be high
What are the other addition symptoms you can often see that happens with pre-eclampsia in addition to the proteinuria?
Thrombocytopenia (low platelet) Abnormal liver enzymes like ALT , AGT etc Creatinine labs high from renal issues Vision disturbances Pulmonary edema
What is Eclampsia?
When is the onset?
New onset of hypertension in pregnancy with proteinuria but also a seizure or coma with someone without hx of any of this happening
- New HTN
- Proteinuria
- Seizure/Coma
Onset for the actual eclampsia can be during PG, labor, or early postpartum
What is chronic hypertension? Is it the same things as the 3 hypertensions of gestational, pre-eclampsia, and eclampsia?
How is the chronic hypertension treated?
It is when the woman has hypertension before she was ever even pregnant and it stays long after she delivers
Methyldopa: Aldamet
Labetalol
Thriazide diuretics or Nifedipine diuretics
What is it called when a pregnant woman who ALREADY had chronic hypertension starts to develop pre-eclamptic symptoms like proteinuria?
Superimposed Preeclampsia.
Again, this is chronic hypertension she already had. But maybe now she is spilling protein. Having thrombocytopenia, liver issues, renal problems, pulmonary edema, visual problems, etc
When is the usual timing of pre-eclampsia?
Beyond 20 weeks usually but most prominent in the 30-40 week mark, during labor, or 48 hours after delivery. This is the time frame when those pre-eclampsia symptoms really show up.
T/F
Pre-eclampsia, eclampsia, and superimposed eclampsia can all show up while PG, during labor, and postpartum.
True! Just bc you are done being pregnant doesn’t mean you’re out of the woods yet.
What ages can put you at more risk of having Pre-eclapmsia?
Teenagers but also the older gravida moms as well.
So opposite ends of the spectrum
Why is that those women who are in their FIRST pregnancy have a higher risk of getting pre-eclampsia than say a woman who is in her third pregnanct?
We assume pre-eclampsia is an autoimmune response due to a foreign body (the fetus) being in the mom’s body.
What are the chances of you being pre-eclamptic if you’ve had it before?
17% chance and so yes people who’ve has previous hx are at higher risk
Which race is more likely to have pre-eclampsia?
African Americans
Who has a higher risk of pre-eclampsia: a mom carrying one baby or a mom with multiple gestations (twins)?
Mom with twins has higher odds of being pre-eclamptic
This type of fertilization risk can increase Pre-eclampsia odds
In vitro fertilization w donor eggs
Types of blood disorder conditions that increase risk of pre-eclampsia?
Factor 5 Leiden
Antiphospholipid
Antibody syndrome
- but many of these people are on aspirin or heparin so make sure to ask if WHY someone is taking these meds to figure out if its the blood clotting disorder
Do scientists understand the patho of pre-eclampsia?
No they don’t because women are all different BUT they do know it has something to do with the placenta and it is progressive (and it won’t go away until you deliver).
What happens to the vessels of Pre-eclamptic women versus what normally happens?
Pre-eclamptic women’s vessels constrict which is abnormal since pregnancy usually should make you dilate your vessels. And so this leads to a lack of perfusion which effects organs and fetus. Baby can come out SGA from lack of O2 or decreased in active, or even having non-reassuring status.
So again, since the vessels of pre-eclamptic women are not acting right, what happens to the baby?
The constriction leads to less O2 for the baby. Baby can be SGA, have decreased movement, or even have a non-assuring status.
T/F
Pre-eclamspia actually doesn’t affect the kidneys
(Uric acid?)
False. Pre-eclampsia causes less perfused to the Kindeys and this affects the GFR. She begins to leak protein (PROTEINURIA!!) and urine output turns oliguric (less).
Uric acid will go up now bc it isn’t being excreted.
T/F
Pre-eclampsia causes decreased endothelial permeability
False.
The permeability of the endothelial increases which results in the edema you see in PG.
Hematocrit goes up.
Thrombocytopenia causes thick blood (which does not help constricting vessels btw)
T/F
Pre-eclampsia women don’t have to worry about pulmonary edema due to the mother and fetal circulation being different
False. Mom is at risk for pulmonary edema due to the increased capillary permeability that comes from endothelial permeability
We mentioned that thrombocytopenia or low platelets can happen too with pre-eclampsia in addition to the proteinuria. Why is this?
The coagulation cascade is activated but also because endothelial damage and so platelets are lost
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