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ENRP II > Hypertensive Disorders in Pregnancy > Flashcards

Hypertensive Disorders in Pregnancy Flashcards

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
Q

when do you procceed with delivery of a baby with a mom with chronic SEVERE HTN

A

37-39 weeks

26
Q

what is gestational HTN

A

HTN that occurs after 20 weeks gestation that occurs within 48-72 hours after delivery and resolves by 12 weeks post partum

27
Q

hypertensive disorders are a _ in pregngnacy

A

continuum

28
Q

precclampsia triad***

triad no longer recongized, one feature is common to a lot of pregnancies

A

Proteinuria
HTN
(edema)

29
Q

symptoms of preeclampsia

A

scotoma- blind spot/partial vision loss

blurred vision

epigastric pain/ right upper quadrant pain

headache

30
Q

risk factors for preecalampsia

A

nulliparity, african americans, history of preeclampsia, chronic HTN, multifetal gestation, pre-gestational diabetes, collagen vasular disease (SLE) and more!

31
Q

preeclampsia, what happens and where?

A

Brain- headache
Heart-edema
Lungs- pulmonary edema
Liver- right upper quadrant pain
Kidneys- Proteinuria/edema
Eyes: vision changes

32
Q

in preeclampsia the brain is effected and a headacahe occurs, why does a patient get a headache

A

due to cerebral edema

33
Q

in preeclampsia why does the heart get edema?

A

there is an absence of normal intravscular volume expansion (third spacing) and a reduction in circulating blood volume

seen as lower extremity edema

there will be a false increase in hemoglobin and hematocrit

34
Q

why do the lungs get pulmonary edema in preeclampsia

A

non cardiogenic pulmonary edema because there is a change in colloid osmotic pressure, capillary endotheelial integrity and intravascular hydrostatic vessels.

ultimately leaky vessels

35
Q

why does the liver have RUQ pain when there is preeclampsia

A

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
Q

why do the kidneys have edema/proteinuria in preeclampsia

A

there is a narrowing of the capilalry lumen and swelling og the glomerular capillary endothelial cells

(leaky vessels and cant filter)

37
Q

what vision changes are seen in preeclampsia

A

retinal vasopasm and retinal edema

38
Q

what is the cause of preeclampsia

A

the eitiology is unknown

lost of proposed theories: chronic uteroplacental ischemia, LDL toxicity, etc.

39
Q

what are the parameters for mild precelampsia

A

greater than 140/90 but less than 160/110

40
Q

how much protein is in the urine in preeclampsia

24 hour-

protein creatinine ratio-

urine dipstick-

A

24 hr: greater than 300mg/24 hours

protein: creatinine ratino: 0.3 mg/DL

urine dipstick : +2

41
Q

what are the parameters for severe preeclampsia with severe features

urine
liver
lung
platelets
cerebral

A

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
Q

preeclampsia evaluation

A

complete history: past history of HTN, renal disease?

address physical symptoms: headahce, visual changes, vaginal bleeding, epigastric pain

43
Q

examination findings in preeclampsia

A

brisk relfexes
clonus - muscle spams, repeated

edema

44
Q

laboratory findings in preeclampsia

A

increased: hematocrit, lactate dehydrogenase, AST/ALT, uric acid

low platelets: thrombocytopenia

45
Q

how do you manage a preeclamptic patient without severe features

less than 37 weeks

between 37-40 weeks

A

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
Q

how do you manage patients with severe preelampsia with severe features

A

hospitalize!

deliver if greater than 34 weeks

manage blood pressure

administer corticosteroids if less than 37 weeks and work towards deliver

47
Q

_ is adminsitered for sezuire prohylaxis ( always in severe ecclampsia)

A

magnesium sulfate

48
Q

intrapartum management

A

vaginal delivery is preferred, mag. sulfate, cervical rippening, pain management

49
Q

magnesium sulfate is administered via _

A

IV

seizure prohylaxis

50
Q

loading dose for magnesium sulfate in preeclampsia

A

4 gm

51
Q

maintenance dose of magnesium sulfate for preeclampsia

A

2gm

52
Q

theraputic value of mg sulfate

A

4-6 mg/dl

53
Q

mag >9

mag > 15

mag>30

symptoms

magenesium sulfate toxicity

A

> 9= loss of patellar reflexes

> 15= respiratory paralysis

> 30 cardiac arrest

54
Q

how do you reverse magnesium sulfate overload

A

calcium gluconate

55
Q

during magnesium sulfate administration you should have fluid _ (administration/restriction)

A

restriction

to prevent overload/pulmonary edema

56
Q

should you continue mag. sulfate after delivery

A

yes for about 24 hrs after

57
Q

first thing to do in a eclamptic patient

first line treatment

second line treatment if persistent seizures

A

protect the airway

magnesium sulfate

lorezepam if persistent

58
Q

is eclampsia an indication for C-section

A

no

59
Q

what is HELLP syndrome

A

a variant of preeclampsia that stands for Hemolysis, Elevated Liver Enzymes, and low platelets

60
Q

labs for hellp syndrome

should you deliver them?

A

LDH greater than 600
AST/ALT elevated twice the upper limit of normal
platelets less than 100,000

deliver immediately

presence of HTN and proteinuria are variable!!!

61
Q

prevention of preeclampsia

medication

A

aspirin

ENRP II (25 decks)

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