Hypertensive Disorders in Pregnancy Flashcards
What is the definition of high blood pressure?
-sustained bp higher than 140/90
Chronic htn
-present before or recognized during first half of pregnancy
gestational htn
-recognized after 20 weeks gestation
preeclampsia
-occurs afer 20 weeks gestation and coexists with proteinuria
eclampsia
-new onset seizure activity associated with preeclampsia
superimposed preeclampsia/eclampsia
-transposed onto chronic htn
What do we need to do for chronic htn evaluation?
-rule out underlying disorders
What is mild htn?
-bp less than 160/110
gestational htn?
- htn WITHOUT any features of preeclampsia
- occurs after 20 weeks gestation
- or within 48-72 hrs after delivery
- resolves by 12 weeks postpartum
- true diagnosis is made in retrospect
how to diagnoses preeclampsia
- htn
- proteinuria
- edema
symptoms of preeclampsia
- scotoma
- blurred vision
- epigastric and/or right upper quadrant pain
- headache
what are some risk factors for preeclampsia?
- primigravid
- diabetes
- thyroid diseases… etc
why might someone with preeclampsia have right upper quadrant pain?
- stretching of glisson’s capsule!
- this is in the liver
- subcapsular hematoma…. liver rupture
what is the difference between mild and severe preeclampsia?
- whether they’re symptomatic or not
- BP between 140/90 and 160/110
- oliguria: less than 500 mL in 24 hours
examination findings for preeclampsia
- brisk reflexes
- clonus
- edema?
lab findings for preeclampsia?
- increased hematocrit, LDH, AST and ALT, and Uric Acid
- thrombocytopenia
how do you manage preeclampsia without severe features?
- if less than 37 weeks: bed rest, fetal growth ultrasounds… etc
- if b/w 37-40 weeks: maybe cervix induction, if unfavorable cervix, use a cervical ripening agent to begin induction
Management of preeclampsia with severe features
- Immediate hospitalization
- delivers if greater than 34 weeks
- give antihypertensives
- give corticosteroids if less than 37 weeks… make delivery happen sooner rather than later
What are some antihypertensives that we can give?
- Hydralazine
- Labetalol
- Nifedipine
What is the preferred method for delivery with these patients?
-vaginal
What is the tocolytic drug we can give them for preeclampsia with severe features?
- 4 gm loading dose of MgSO4
- keep betwen 4.8-9.6
What do we give to reverse the effects of MgSO4 if there’s too much?
-calcium gluconate
What is the main distinguishing thing that ppl with eclampsia have?
-seizures
What is the first line treatment with eclampsia?
- MgSO4
- may need diazepam or lorezepam if persistent
What is HELLP syndrome?
- variant of preeclampsia
- hemolysis, elevated liver enzymes, low platelets
- RUQ pain, nausea and vomiting are common
- immediate delivery!
What might we give someone with a hx of preeclampsia to help prevent it?
-aspirin
