Hypertensive Disorders in Pregnancy

Question 1

What is the definition of high blood pressure?

Answer 1

-sustained bp higher than 140/90

Question 2

Chronic htn

Answer 2

-present before or recognized during first half of pregnancy

Question 3

gestational htn

Answer 3

-recognized after 20 weeks gestation

Question 4

preeclampsia

Answer 4

-occurs afer 20 weeks gestation and coexists with proteinuria

Question 5

eclampsia

Answer 5

-new onset seizure activity associated with preeclampsia

Question 6

superimposed preeclampsia/eclampsia

Answer 6

-transposed onto chronic htn

Question 7

What do we need to do for chronic htn evaluation?

Answer 7

-rule out underlying disorders

Question 8

What is mild htn?

Answer 8

-bp less than 160/110

Question 9

gestational htn?

Answer 9

• 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

Question 10

how to diagnoses preeclampsia

Answer 10

• htn
• proteinuria
• edema

Question 11

symptoms of preeclampsia

Answer 11

• scotoma
• blurred vision
• epigastric and/or right upper quadrant pain
• headache

Question 12

what are some risk factors for preeclampsia?

Answer 12

• primigravid
• diabetes
• thyroid diseases… etc

Question 13

why might someone with preeclampsia have right upper quadrant pain?

Answer 13

• stretching of glisson’s capsule!
• this is in the liver
• subcapsular hematoma…. liver rupture

Question 14

what is the difference between mild and severe preeclampsia?

Answer 14

• whether they’re symptomatic or not
• BP between 140/90 and 160/110
• oliguria: less than 500 mL in 24 hours

Question 15

examination findings for preeclampsia

Answer 15

• brisk reflexes
• clonus
• edema?

Question 16

lab findings for preeclampsia?

Answer 16

• increased hematocrit, LDH, AST and ALT, and Uric Acid

- thrombocytopenia

Question 17

how do you manage preeclampsia without severe features?

Answer 17

• 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

Question 18

Management of preeclampsia with severe features

Answer 18

• Immediate hospitalization
• delivers if greater than 34 weeks
• give antihypertensives
• give corticosteroids if less than 37 weeks… make delivery happen sooner rather than later

Question 19

What are some antihypertensives that we can give?

Answer 19

• Hydralazine
• Labetalol
• Nifedipine

Question 20

What is the preferred method for delivery with these patients?

Answer 20

-vaginal

Question 21

What is the tocolytic drug we can give them for preeclampsia with severe features?

Answer 21

• 4 gm loading dose of MgSO4

- keep betwen 4.8-9.6

Question 22

What do we give to reverse the effects of MgSO4 if there’s too much?

Answer 22

-calcium gluconate

Question 23

What is the main distinguishing thing that ppl with eclampsia have?

Answer 23

-seizures

Question 24

What is the first line treatment with eclampsia?

Answer 24

• MgSO4

- may need diazepam or lorezepam if persistent

Question 25

What is HELLP syndrome?

Answer 25

• variant of preeclampsia
• hemolysis, elevated liver enzymes, low platelets
• RUQ pain, nausea and vomiting are common
• immediate delivery!

Question 26

What might we give someone with a hx of preeclampsia to help prevent it?

Answer 26

-aspirin