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RGU 2 > Hypertensive Disorders in Pregnancy > Flashcards

Hypertensive Disorders in Pregnancy Flashcards

1
Q

What is the maternal complication of hypertensive disorders of pregnancy?

A
  • end organ damage
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2
Q

What are the fetal complications of hypertensive disorders of pregnancy?

A
  • prematurity
  • growth restriction
  • death
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3
Q

What is considered hypertension?

A
  • greater than 140/90
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4
Q

** What are the 4 categories of hypertensive disorders of pregnancy?

A
  1. chronic hypertension
  2. preeclampsia/eclampsia
  3. chronic hypertension with superimposed preeclampsia/eclampsia
  4. gestational hypertension
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5
Q

** What is chronic hypertension? (TEST QUESTION)

A
  • known hypertension prior to pregnancy or developing before the 20th week of gestation. This will be there at least 12 weeks (3 months) post partum.
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6
Q

What causes chronic hypertension?

A
  • primary cause= “essential hypertension” (aka don’t know)
  • secondary causes= metabolic disorders including renal disease, vascular disease, and endocrine disorders. Stress of pregnancy may bring out the fact that this woman is a chronic hypertensive.
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7
Q

** How do we manage chronic hypertension?

A
  • obtain labs: CBC, BUN, creatinine, LFTs, 24 hr urine for protein and creatinine, urinalysis.
  • EKG
  • observe for superimposed preeclampsia
  • observe for intrauterine growth restriction (IUGR).
  • control BP between 140-150/90-100 (want it higher to ensure perfusion to baby bc it requires a high pulse pressure to get the blood to the baby).
  • deliver at term if no complications
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8
Q

What percent of pregnant women with chronic hypertension will also get superimposed preeclampsia?

A
  • 20%
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9
Q

*** Will pregnancy exacerbate chronic hypertension?

A

NO

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10
Q

** What is preeclampsia? (TEST QUESTION)

A
  • NEW onset of HTN AND PROTEINURIA during latter half of gestation (after 20 weeks).
  • greater than 140/90 at rest on 2 occasions in a sitting position 6 hrs apart.
  • proteinuria greater than 0.3 g in a 24 hour urine collection.
  • may be associated with edema, headache, visual changes, or epigastric pain.
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11
Q

If you were thinking preeclampsia, but it is sooner than 20 weeks, what should you think now?

A

Molar pregnancy

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12
Q

*** What are the 2 categories of preeclampsia?

A
  1. MILD
  2. SEVERE= severe HTN (systolic greater than 160 or diastolic 110 mm Hg) at rest, on 2 occasions at least 6 hours apart + heavy proteinuria (at least 5 g in a 24 hr collection or a qualitative value of 3+ in urine samples collected 4 hrs apart).
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13
Q

What will you see with SEVERE preeclampsia? (think what happens when your vessels clamp down)

A
  • cerebral or visual disturbances
  • pulmonary edema or cyanosis
  • RUQ pain
  • impaired liver function (elevated LFTs)
  • thrombocytopenia
  • fetal growth restriction
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14
Q

*** What is eclampsia?

A
  • new-onset of TONIC-CLONIC SEIZURES in a woman with preeclampsia
  • most happen during labor, but can happen before or after as well.
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15
Q

** What is chronic hypertension with superimposed preeclampsia?

A
  • chronic hypertension with new-onset proteinuria (greater than 0.3 g in a 24 hr collection) after the 20th week of gestation.
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16
Q

** What is gestational hypertension? (TEST QUESTION)

A
  • post partum diagnosis.
  • defined as HTN occurring after the 20th week of gestation WITHOUT proteinuria.
  • may occur 48-72 hours post partum, but will resolve by the 12th post partum week.
17
Q

*** What is HELLP syndrome?

A
  • variation of severe preeclampsia:
  • H= hemolysis
  • EL= elevated liver enzymes
  • LP= low platelets
  • BP may be initially normal, mildly elevated or severely elevated. Important to recognize HELLP and treat them as if they have severe eclampsia.
18
Q

In what pts do you see HELLP most often?

A
  • multiparous (have had multiple babies)
  • greater than 25 years old
  • less than 36 weeks gestation
19
Q

What is the causes of preeclampsia?

A
  • unknown, but likely genetic and involving the placenta and membranes.
  • UTEROPLACENTAL ISCHEMIA definitely is a cause.
20
Q

** What is the management for preeclampsia?

A
  • if mild= observation with weekly non-stress tests or biophysical profiles.
  • if severe= DELIVERY
21
Q

What do you do if you need to deliver the baby due to preeclampsia and it’s less than 34 weeks?

A

give STEROIDS to help lung development

22
Q

How do you manage intrapartum (during delivery) preeclampsia?

A
  • MAGNESIUM SULFATE for seizure prophylaxis

- BP control with hydralazine or labetalol

23
Q

How do you manage eclampsia (aka they are seizing)?

A
  • maintain airway
  • IV access
  • Magnesium sulfate
  • blood pressure recordings

RGU 2 (24 decks)

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