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ENRP II > Hypertensive Disorders in Pregnancy > Flashcards

Hypertensive Disorders in Pregnancy Flashcards

(61 cards)

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1
Q

what are some fetal complications of chronic hypertension

A

fetal growth restriction
preterm birth
placental abruptions
still birth
congenital anomalies

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2
Q

what are some maternal risks of chronic HTN

A

liver failure, kidney failure, preeclampsia/eclampsia

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3
Q

normal blood pressure ranges

A

less than 120/80

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4
Q

what is elevated blood pressure ranges

A

120-129/80

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5
Q

what is stage 1 hypertension ranges

A

130-139/80-89

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6
Q

what is stage 2 hypertesion ranges

A

> 140/90

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7
Q

what are hypertensive crisis ranges?

A

180/120

may have signs of end organ damage

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8
Q

what are the parameters for chronic hypertension?

A

present before or recognized during the first half of pregnancy and persists after 12 week postpartum

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9
Q

what is gestational hypertension

A

hypertension recognized after 20 weeks gestation

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10
Q

what is pre-eclampsia

A

gestational HTN with proteinuria and sometimes edema

can be superimposed on chronic HTN

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11
Q

what is ecclampsia?

A

pre-eclampsia + clonic tonic seizures

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12
Q

what is superimposed pre-eclampsia/eclampsia

A

pre-clampsia/eclampsia transposed onto chronic HTN

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13
Q

most causes of chronic hypertension are?

A

idiopathic

(can also be vascular disorders, endocrine disorders, renal disorders, Connective tissue disorders)

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14
Q

how do you take an acurate blood pressure

A

patient seated after resting for 10 minutes with legs uncrossed and back supported

use appropriate cuff size

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15
Q

appropriate cuff sice for blood pressure

A

length 1.5 times the upper arm circumfrence

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16
Q

how do you evaluate chronic HTN in pregnancy

A

rule out underlying disease

assess for end organ damage (CBC, CMP, EKG, 24 hour urine collection)

check for fetal well being
- initial ultrasound for accurate dating
- screening ultrasound

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17
Q

for a mother with chronic HTN when should you do growth ultrasounds ?

A

monthly after 28 weeks

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18
Q

antepartum fetal testing begins when in a mother with chronic HTN

A

32-34 weeks gestation

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19
Q

mild chronic HTN in pregnancy. people range, how do you treat

A

less than 160/110

begin asprin therapy at 81 mg daily at 12 weeks until delivery

initiate antihypertensive medication if the threshold above is met

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20
Q

how frequently are appointments with chronic mild HTN in pregnancy

A

prenantal visits 2-4 weeks until 34-36 weeks

then weekly

with antepartum fetal testing : NST, Biophysical profile

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21
Q

when do you proceed to delivery in a mother with chronic MILD HTN

A

38-39 weeks gestation

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22
Q

how do you manage a mom with SEVERE chronic HTN in pregnancy

BP: over 160/110

pharmacetically

A

start a antihypertensive!
methyldopa
labetolol
nifedipine

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23
Q

what antihypertensives should you avoid in pregnancy and what are their side effects

A

Ace inhibitors ad angiotensin receptor blockers

they result in fetal growth restrictions, clavarial hypoplasia, malformations

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24
Q

how do you manage a pregnant patient with SERVER HTN (over 160/110)

A

CLOSE MONITORING

24 hour urine collection every trimester

observe for signs of precclampsia/ecclapmsia

antepartum fetal surveillance with ultrasounds and nonstress tests/biophysical profiles

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25
when do you procceed with delivery of a baby with a mom with chronic SEVERE HTN
37-39 weeks
26
what is gestational HTN
HTN that occurs after 20 weeks gestation that occurs within 48-72 hours after delivery and resolves by 12 weeks post partum
27
hypertensive disorders are a _ in pregngnacy
continuum
28
precclampsia triad*** ## Footnote triad no longer recongized, one feature is common to a lot of pregnancies
Proteinuria HTN (edema)
29
symptoms of preeclampsia
scotoma- blind spot/partial vision loss blurred vision epigastric pain/ right upper quadrant pain headache
30
risk factors for preecalampsia
nulliparity, african americans, history of preeclampsia, chronic HTN, multifetal gestation, pre-gestational diabetes, collagen vasular disease (SLE) and more!
31
preeclampsia, what happens and where?
Brain- headache Heart-edema Lungs- pulmonary edema Liver- right upper quadrant pain Kidneys- Proteinuria/edema Eyes: vision changes
32
in preeclampsia the brain is effected and a headacahe occurs, why does a patient get a headache
due to cerebral edema
33
in preeclampsia why does the heart get edema?
there is an absence of normal intravscular volume expansion (third spacing) and a reduction in circulating blood volume seen as lower extremity edema ## Footnote there will be a false increase in hemoglobin and hematocrit
34
why do the lungs get pulmonary edema in preeclampsia
non cardiogenic pulmonary edema because there is a change in colloid osmotic pressure, capillary endotheelial integrity and intravascular hydrostatic vessels. ultimately leaky vessels
35
why does the liver have RUQ pain when there is preeclampsia
sinusoidal fibrin deposition in the periportal areas with hemorrage cause a subscapular hematoma and liver rupture the stretching of glissons caspule is the pain felt
36
why do the kidneys have edema/proteinuria in preeclampsia
there is a narrowing of the capilalry lumen and swelling og the glomerular capillary endothelial cells (leaky vessels and cant filter)
37
what vision changes are seen in preeclampsia
retinal vasopasm and retinal edema
38
what is the cause of preeclampsia
the eitiology is unknown lost of proposed theories: chronic uteroplacental ischemia, LDL toxicity, etc.
39
what are the parameters for mild precelampsia
greater than 140/90 but less than 160/110
40
how much protein is in the urine in preeclampsia 24 hour- protein creatinine ratio- urine dipstick-
24 hr: greater than 300mg/24 hours protein: creatinine ratino: 0.3 mg/DL urine dipstick : +2
41
what are the parameters for severe preeclampsia with severe features urine liver lung platelets cerebral
BP: greater than 160/110 on 2 occasions 4 hours apart oliguria (less than 500 ml in 24 hours) liver enzymes twice the upper limit of normal pulmonary edema thrombocytopenia new headache: refractory to medication
42
preeclampsia evaluation
complete history: past history of HTN, renal disease? address physical symptoms: headahce, visual changes, vaginal bleeding, epigastric pain
43
examination findings in preeclampsia
brisk relfexes clonus - muscle spams, repeated edema
44
laboratory findings in preeclampsia
increased: hematocrit, lactate dehydrogenase, AST/ALT, uric acid low platelets: thrombocytopenia
45
how do you manage a preeclamptic patient without severe features less than 37 weeks between 37-40 weeks
less than 37 weeks: BPP once a week or NST twice a week, fetal growth ultrasound, possible hospitalization 37-40 weeks: begin induction if cervix is favorable if not rippen cervic and then begin induction
46
how do you manage patients with severe preelampsia with severe features
hospitalize! deliver if greater than 34 weeks manage blood pressure administer corticosteroids if less than 37 weeks and work towards deliver
47
_ is adminsitered for sezuire prohylaxis ( always in severe ecclampsia)
magnesium sulfate
48
intrapartum management
vaginal delivery is preferred, mag. sulfate, cervical rippening, pain management
49
magnesium sulfate is administered via _
IV ## Footnote seizure prohylaxis
50
loading dose for magnesium sulfate in preeclampsia
4 gm
51
maintenance dose of magnesium sulfate for preeclampsia
2gm
52
theraputic value of mg sulfate
4-6 mg/dl
53
mag >9 mag > 15 mag>30 symptoms ## Footnote magenesium sulfate toxicity
>9= loss of patellar reflexes >15= respiratory paralysis >30 cardiac arrest
54
how do you reverse magnesium sulfate overload
calcium gluconate
55
during magnesium sulfate administration you should have fluid _ (administration/restriction)
restriction to prevent overload/pulmonary edema
56
should you continue mag. sulfate after delivery
yes for about 24 hrs after
57
first thing to do in a eclamptic patient first line treatment second line treatment if persistent seizures
protect the airway magnesium sulfate lorezepam if persistent
58
is eclampsia an indication for C-section
no
59
what is HELLP syndrome
a variant of preeclampsia that stands for Hemolysis, Elevated Liver Enzymes, and low platelets
60
labs for hellp syndrome should you deliver them?
LDH greater than 600 AST/ALT elevated twice the upper limit of normal platelets less than 100,000 deliver immediately ## Footnote presence of HTN and proteinuria are variable!!!
61
prevention of preeclampsia ## Footnote medication
aspirin

ENRP II (25 decks)

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