Hypertensive Disorders in Pregnancy Flashcards
Hypertensive Disorders in Pregnancy ?
Gestational Hypertension
Preeclampsia
Eclampsia
HELLP Syndrome
Gestational Hypertension Mild criteria ?
Mild >140 systolic or >90 diastolic
Gestational Hypertension severe ?
Severe >160 systolic, >110 diastolic
Gestational Hypertension sxs ?
2 occasions, 6 hours apart
Previously normotensive
No proteinuria
Gestational Hypertension increased risk of ?
preterm birth, IUGR, placental abruption
Gestational Hypertension Tx. ?
Monitor for progression to preeclampsia
Mild – monthly US, no meds, delivery at 39-40 weeks
Severe – same tx as preeclampsia
Preeclampsia prevalence ?
5-7%
Preeclampsia HTN ?
(>140 or >90, 2 occasions, 6 hours apart)
Normally, BP goes down in first half of pregnancy with return to normal at term
Preeclampsia proteinuria ?
(>300 mg in a 24-hour specimen)
Preeclampsia Etiology ?
Etiology unknown, but endothelial injury results
Preeclampsia sxs ?
HTN
proteinuria
Edema
Preeclampsia RF ?
Age <20 or >35
Nulliparity
Multiple gestation
Hydatidiform mole
DM
Thyroid disease
Renal disease
Family history of preeclampsia
Personal history of preeclampsia
Preeclampsia prevention ?
Low-dose aspirin – mixed results
Calcium supplements 1 gram daily
Preeclampsia clinical findings ?
Elevated BP, proteinuria
May also have
- Scotoma, blurred vision, RUQ pain
- -vasculopathy in the eyes
Brisk DTR’s, clonus
Preeclampsia complications ?
Preterm birth, IUGR, placental abruption, maternal pulmonary edema, eclampsia
Preeclampsia - Treatment: mild ?
Hospitalize vs outpatient monitoring
-Monitor weight, BP, DTR’s, proteinuria, fetal movement
Assess fetal maturity, corticosteroids if needed to help lungs mature (if not too dangerous to wait)
Mag sulfate not helpful
Preeclampsia - Treatment: severity ?
(>160/>110, 5 g proteinuria/day, oliguria, pulm edema)
Must admit
Delivery if 34+ weeks, lungs mature or deteriorating mat/fetal status
BP control to <160/<105 with IV hydralazine, labetalol or nifedipine
Mag sulfate to reduce development of eclampsia
Eclampsia sxs. ?
Hypertension
Proteinuria
*Seizures
Eclampsia: Seizures information ?
Usually self-limiting, lasting 1-2 minutes
Mag sulfate to prevent recurrent seizures
Diazepam, lorazepam if sustained seizures
Seizures cause prolonged FHR decrease
Eclampsia Tx. ?
Need immediate delivery – vaginal or C-section
HELLP Syndrome aka ?
Hemolysis,
Elevated Liver enzymes,
Low Platelets
HELLP syndrome = In the spectrum of preeclampsia/eclampsia but a minority of patients will be ___________ and/or not have __________
normotensive
proteinuria
HELLP syndrome usually occur in the ___ trimester
3rd
HELLP Syndrome etiology ?
UKN
HELLP Syndrome sxs. ?
Abdominal pain,
N/V,
malaise,
often elevated BP,
proteinuria
HELLP Syndrome labs ?
(ALL are needed to diagnose)
Hemolysis (schistocytes on peripheral smear)
Elevated bilirubin or elevated
LDH
Platelets <100,000
AST >70
Some may also have elevated PT/PTT
HELLP Syndrome complications ?
DIC,
placental abruption,
ARF,
pulmonary edema,
hepatic rupture
HELLP Syndrome tx. ?
Blood and coag factor replacement
Tx HTN if needed
Delivery is primary tx
HELLP Syndrome prognosis ?
Majority of patients improve with prompt recognition and tx
Exposure to Fetotoxic Agents: examples of teratogens ?
Viruses
Chemicals
Medications
Exposure to Fetotoxic Agents: consider gestational age because organogenesis begins at ____ weeks
2-8
is the worst time! cause organ development
Exposure to Fetotoxic Agents: difficult to predict outcome soo ?
council parents
