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Year 2 OBGYN > Hypertensive disorders in pregnancy > Flashcards

Hypertensive disorders in pregnancy Flashcards

1
Q

does BP usually go up or down during the 1st trimester? why?

A

down

  • increased maternal blood volume
  • decreased colloid oncotic pressure
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2
Q

when is the lowest maternal BP during pregnancy?

A

13-20 weeks

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3
Q

what are the four types of HTN during pregnancy?

A
  • chronic
  • gestational
  • preeclampsia
  • preeclampsia superimposed on chronic HTN
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4
Q

chronic HTN: definition

A
  • BP 140/90 prior to or during first 20 weeks of pregnancy
  • no proteinemia
  • BP remains elevated over 12 weeks postpartum
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5
Q

what are the common obstetrical complications to severe chronic HTN?

A
  • superimposed preeclampsia
  • premature birth
  • intrauterine growth restriction
  • fetal demise
  • placental abruption
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6
Q

what is the management for chronic HTN?

A

lifestyle modification

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7
Q

when do you start hypertensive medication for chronic HTN?

A

when BP is over 160/110 or

continue pre-pregnancy treatment if

  • multiple medications were required pre-pregnancy
  • evidence of preexisting end organ dysfunction
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8
Q

what are the signs of preeclampsia?

A
  • development of proteinuria

- sudden increase in BP when previously well-controlled

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9
Q

definition: gestational HTN

A
  • nonproteinuric HTN after 20 weeks gestation

provisional diagnosis including

  • women who go on to develop preeclampsia
  • women with previously undiagnosed chronic HTN
  • women who do not develop preeclampsia and whose blood pressures normalize postpartum

mild (under 160/110) or severe (over 160/110)

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10
Q

what is the management for mild gestational HTN?

A

expectant management

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11
Q

what is the management for severe gestational HTN?

A

same as for severe preeclampsia

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12
Q

definition: preeclampsia

A
  • new onset HTN and proteiuria after 20 weeks gestation in a previously normotensive woman
  • BP over 140 systolic OR over 90 diastolic on 2 separate occasions at least 6 hours apart
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13
Q

definition: mild preeclampsia

A
  • BP 140/90 on 2 separate occasions at least 6 hours apart AND proteinuria over 0.3 g in a 24 hour urine specimen
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14
Q

definition: severe preeclampsia

A
  • systolic over 160 or diastolic over 110 on two occasions at least 4 hours apart while at bedrest
  • thrombocytopenia
  • impaired liver function
  • progressive renal insufficiency
  • pulmonary edema
  • new onset cerebral or visual disturbances
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15
Q

preeclampsia can mimic what other diseases?

A
  • flu
  • gall bladder disease
  • migraines
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16
Q

what are the pregnancy associated risk factors for preeclampsia?

A
  • chromosome abnormalities
  • hydatidiform mole
  • hydrops fetalis
  • multifetal pregnancy
  • oocyte donation or donor insemination
  • structural congenital abnormalities
17
Q

what are the maternal specific risk factors for preeclampsia?

A
  • age under 20, over 35
  • African American
  • family history of preeclampsia
  • NULLIPARITY**
  • preeclampsia in previous pregnancy
  • stress
  • medical conditions (obesity, thrombophilias, antiphospholipid Ab syndrome)
18
Q

definition: eclampsia

A

appearance of seizures in a patient with preeclampsia

19
Q

definition: HELLP syndrome

A

a variant of preeclampsia with:

  • hemolysis
  • elevated liver enzymes
  • low platelet count
20
Q

what are the lab findings for the hemolysis portion of HELLP syndrome?

A
  • abnormal peripheral smear (burr cells, schistocytes, or other abnormal RBC forms)
  • LDH over 600
  • bilirubin over 1.2
21
Q

what are the lab findings for the elevated liver enzymes portion of HELLP syndrome?

A

AST or ALT over 100 IU/L

22
Q

what are the lab findings for the low platelets portion of HELLP syndrome?

A

under 100,000 / mm3

23
Q

what is the ultimate cure for preeclampsia?

A

delivery

24
Q

what are the two key management goals for preeclampsia?

A
  • control HTN

- prevent seizures

25
Q

what is given for seizure control in eclampsia?

A

magnesium sulfate

26
Q

what are the maternal indications for delivery?

A
  • over 37 weeks gestation
  • worsening labs
  • suspected fetal abruption
  • persistent headache or vision changes
  • persistent severe nausea, vomiting, epigastric pain
  • ECLAMPSIA
27
Q

what are the fetal indications for deliver?

A
  • severe intrauterine growth retardation
  • nonreassuring fetal surveillance
  • oligohydramnios
28
Q

when is seizure risk greatest in postpartum management?

A

first 24 hours

29
Q

what are the postpartum complications in the presence of preeclampsia and severe chronic HTN?

A
  • pulmonary edema
  • heart failure
  • hypertensive encephalopathy
  • renal failure
30
Q

definition: intrauterine growth restriction (IUGR)

what is necessary for diagnosis?

A
  • estimated fetal weight under 10th percentile for gestational age (symmetric / assymetric)
  • US is necessary for diagnosis
31
Q

definition: assymetric IUGR?

A

disproportionately lagging in abdominal growth

  • fetal head circumference measurement greater than abdominal circumference
  • head sparing
  • placental dysfunction
32
Q

definition: symmetric IUGR?

A

proportionately small

  • a global insult: chromosome abnormality
  • may be constitutionally small parents
33
Q

what is the etiology of IUGR?

A

end result of numerous pathologies which reduce fetal cell size and, when early and severe enough, fetal cell number

34
Q

what are the infection related fetal risk factors for IUGR?

A
  • CMV
  • toxoplasmosis
  • rubella
35
Q

what are chromosomal risk factors for IUGR?

A
  • trisomies (13, 18, 21)
  • trisomy 9 mosaicism
  • trisomy 4p
36
Q

what are the screening tests for IUGR?

A
  • maternal fundal height

- unexplained elevated maternal serum AFP

37
Q

how is diagnosis of IUGR made?

A
  • obstetric US
  • sequential measurement better than single
  • definitive diagnosis at delivery
38
Q

what are special cases of IUGR?

A
  • multiple gestation

- velementous cord insertion, more common in twins

39
Q

what constitutes a RISK for IUGR?

A

when AC is less than 10th percentile for gestational age, but EFW is still above 10th percentile for gestational age

Year 2 OBGYN (33 decks)

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