Hypertensive disorders in pregnancy Flashcards
HTN- maternal risks
- MI
- cardiac failure
- CVA
- renal failure
- hepatic failure
HTN- fetal complications
- fetal growth restriction
- preterm birth
- placental abruption
- stillbirth
- neonatal death
HTN- definition
sustained BP > 140/90
chronic, gestational HTN, preeclampsia, eclampsia, superimposed preeclampsia/eclampsia- definitions
- chronic- present b/f or during 1st half of pregnancy
- gestational- after 20 wks gestation
- preeclampsia- after 20 wks gestation w/ proteinuria
- eclampsia- new onset seizure activity assoc with preeclampsia
- superimposed preeclampsia/eclampsia- transposed onto chronic HTN
chronic HTN- evaluation
- rule out underlying disorders
- assess for maternal end-organ damage
- assess for fetal well being
Mild HTN- management
(BP < 160/110 but > 140/90)
- antihypertensive
- prenatal visits every 2-4 wks until 34-36 wks, then weekly
- antepartum fetal monitoring
- delivery b/w 39-40 wks
Gestational HTN
- after 20 wks gestation
- or within 48-72 hrs after delivery
- resolves by 12 wks postpartum
Preeclampsia- dx, sx
- HTN and proteinuria
- sx- scotoma, blurred vision, epigastric and/or RUQ pain, HA
preeclampsia- risk factors
- age < 20, > 35
- primigravid
- mult gestation
- hydatidiform mole
- diabetes
- chronic HTN
- renal dz
- collagen vascular dz
- antiphospholipid syndrome
- prior hx of preeclampsia
preeclampsia- what happens and where>
- brain- cerebral edema, thrombi
- heart- reduction in circulating blood volume
- lungs- pulm edema
- liver- fibrin
- kidneys
- eyes- retinal vasospasm and edema
Mild preeclampsia (w/o severe features)
- BP > 140/90 but less than 160/110
- proteinuria > 300 mg /24 hr urine but < 5 gm
- asx
Severe preeclampsia (w/ severe features)
- BP > 160/110
- proteinuria > 5 gms/24 hr or + 3 protein on 2 random urine dips
- sx- visual disturbances, pulm edema, RUQ pain, elevated liver enzymes, thrombocytopenia
preeclampsia- exam findings, lab findings
- brisk reflexes, clonus
- inc Hct, lactate dehydrogenase, AST/ALT, uric acid
- thrombocytopenia
mild preeclampsia- management
< 37 wks -bed rest -fetal growth US (every 3-4 wks) 37-40 wks -induction!!
severe preeclampsia- management
- immediate hospitalization
- delivery if > 34 wks
- antihypertensives- hydralazine, labetalol, nifedipine
preeclampsia- intrapartum management
- vaginal delivery preferred
- MgSO4- seizure prophylaxis
Magnesium sulfate
-admin IV for preeclampsia with severe features!!
eclampsia- tx
- protect the airway!!
- MgSO4- first line tx!!
HELLP syndroem
(variant of preeclampsia)
- hemolysis, elevated liver enzymes, low platelets
- immediate delivery!!!!
- RUQ pain, epigastric pain, N/V- common
preeclampsia- prevention
- nothing proven yet
- aspirin!!
