Hypertensive Disorders in Pregnancy Flashcards by Deja Gause

what are some fetal complications of chronic hypertension

fetal growth restriction
preterm birth
placental abruptions
still birth
congenital anomalies

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what are some maternal risks of chronic HTN

liver failure, kidney failure, preeclampsia/eclampsia

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normal blood pressure ranges

less than 120/80

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what is elevated blood pressure ranges

120-129/80

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what is stage 1 hypertension ranges

130-139/80-89

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what is stage 2 hypertesion ranges

> 140/90

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what are hypertensive crisis ranges?

180/120

may have signs of end organ damage

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what are the parameters for chronic hypertension?

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

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what is gestational hypertension

hypertension recognized after 20 weeks gestation

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what is pre-eclampsia

gestational HTN with proteinuria and sometimes edema

can be superimposed on chronic HTN

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what is ecclampsia?

pre-eclampsia + clonic tonic seizures

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what is superimposed pre-eclampsia/eclampsia

pre-clampsia/eclampsia transposed onto chronic HTN

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most causes of chronic hypertension are?

idiopathic

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

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how do you take an acurate blood pressure

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

use appropriate cuff size

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appropriate cuff sice for blood pressure

length 1.5 times the upper arm circumfrence

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how do you evaluate chronic HTN in pregnancy

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

monthly after 28 weeks

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antepartum fetal testing begins when in a mother with chronic HTN

32-34 weeks gestation

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

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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how frequently are appointments with chronic mild HTN in pregnancy

prenantal visits 2-4 weeks until 34-36 weeks

then weekly

with antepartum fetal testing : NST, Biophysical profile

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

38-39 weeks gestation

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

BP: over 160/110

pharmacetically

start a antihypertensive!
methyldopa
labetolol
nifedipine

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

Ace inhibitors ad angiotensin receptor blockers

they result in fetal growth restrictions, clavarial hypoplasia, malformations

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

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

37-39 weeks

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

hypertensive disorders are a _ in pregngnacy

continuum

precclampsia triad*** ## Footnote triad no longer recongized, one feature is common to a lot of pregnancies

Proteinuria HTN (edema)

symptoms of preeclampsia

scotoma- blind spot/partial vision loss blurred vision epigastric pain/ right upper quadrant pain headache

risk factors for preecalampsia

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

preeclampsia, what happens and where?

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

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

due to cerebral edema

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

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

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

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)

what vision changes are seen in preeclampsia

retinal vasopasm and retinal edema

what is the cause of preeclampsia

the eitiology is unknown lost of proposed theories: chronic uteroplacental ischemia, LDL toxicity, etc.

what are the parameters for mild precelampsia

greater than 140/90 but less than 160/110

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

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

preeclampsia evaluation

complete history: past history of HTN, renal disease? address physical symptoms: headahce, visual changes, vaginal bleeding, epigastric pain

examination findings in preeclampsia

brisk relfexes clonus - muscle spams, repeated edema

laboratory findings in preeclampsia

increased: hematocrit, lactate dehydrogenase, AST/ALT, uric acid low platelets: thrombocytopenia

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

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

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

magnesium sulfate

intrapartum management

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

magnesium sulfate is administered via _

IV ## Footnote seizure prohylaxis

loading dose for magnesium sulfate in preeclampsia

4 gm

maintenance dose of magnesium sulfate for preeclampsia

2gm

theraputic value of mg sulfate

4-6 mg/dl

mag >9 mag > 15 mag>30 symptoms ## Footnote magenesium sulfate toxicity

>9= loss of patellar reflexes >15= respiratory paralysis >30 cardiac arrest

how do you reverse magnesium sulfate overload

calcium gluconate

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

restriction to prevent overload/pulmonary edema

should you continue mag. sulfate after delivery

yes for about 24 hrs after

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

is eclampsia an indication for C-section

what is HELLP syndrome

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

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!!!

prevention of preeclampsia ## Footnote medication

aspirin