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Patient Evaluation > Hypertensive Disorders in Pregnancy > Flashcards

Hypertensive Disorders in Pregnancy Flashcards

1
Q

Hypertensive Disorders in Pregnancy ?

A

Gestational Hypertension

Preeclampsia

Eclampsia

HELLP Syndrome

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2
Q

Gestational Hypertension Mild criteria ?

A

Mild >140 systolic or >90 diastolic

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3
Q

Gestational Hypertension severe ?

A

Severe >160 systolic, >110 diastolic

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4
Q

Gestational Hypertension sxs ?

A

2 occasions, 6 hours apart

Previously normotensive

No proteinuria

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5
Q

Gestational Hypertension increased risk of ?

A

preterm birth, IUGR, placental abruption

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6
Q

Gestational Hypertension Tx. ?

A

Monitor for progression to preeclampsia

Mild – monthly US, no meds, delivery at 39-40 weeks

Severe – same tx as preeclampsia

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7
Q

Preeclampsia prevalence ?

A

5-7%

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8
Q

Preeclampsia HTN ?

A

(>140 or >90, 2 occasions, 6 hours apart)

Normally, BP goes down in first half of pregnancy with return to normal at term

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9
Q

Preeclampsia proteinuria ?

A

(>300 mg in a 24-hour specimen)

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10
Q

Preeclampsia Etiology ?

A

Etiology unknown, but endothelial injury results

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11
Q

Preeclampsia sxs ?

A

HTN

proteinuria

Edema

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12
Q

Preeclampsia RF ?

A

Age <20 or >35

Nulliparity

Multiple gestation

Hydatidiform mole

DM

Thyroid disease

Renal disease

Family history of preeclampsia

Personal history of preeclampsia

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13
Q

Preeclampsia prevention ?

A

Low-dose aspirin – mixed results

Calcium supplements 1 gram daily

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14
Q

Preeclampsia clinical findings ?

A

Elevated BP, proteinuria

May also have

  • Scotoma, blurred vision, RUQ pain
  • -vasculopathy in the eyes

Brisk DTR’s, clonus

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15
Q

Preeclampsia complications ?

A

Preterm birth, IUGR, placental abruption, maternal pulmonary edema, eclampsia

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16
Q

Preeclampsia - Treatment: mild ?

A

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

17
Q

Preeclampsia - Treatment: severity ?

A

(>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

18
Q

Eclampsia sxs. ?

A

Hypertension

Proteinuria

*Seizures

19
Q

Eclampsia: Seizures information ?

A

Usually self-limiting, lasting 1-2 minutes

Mag sulfate to prevent recurrent seizures

Diazepam, lorazepam if sustained seizures

Seizures cause prolonged FHR decrease

20
Q

Eclampsia Tx. ?

A

Need immediate delivery – vaginal or C-section

21
Q

HELLP Syndrome aka ?

A

Hemolysis,

Elevated Liver enzymes,

Low Platelets

22
Q

HELLP syndrome = In the spectrum of preeclampsia/eclampsia but a minority of patients will be ___________ and/or not have __________

A

normotensive

proteinuria

23
Q

HELLP syndrome usually occur in the ___ trimester

A

3rd

24
Q

HELLP Syndrome etiology ?

A

UKN

25
Q

HELLP Syndrome sxs. ?

A

Abdominal pain,

N/V,

malaise,

often elevated BP,

proteinuria

26
Q

HELLP Syndrome labs ?

A

(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

27
Q

HELLP Syndrome complications ?

A

DIC,

placental abruption,

ARF,

pulmonary edema,

hepatic rupture

28
Q

HELLP Syndrome tx. ?

A

Blood and coag factor replacement

Tx HTN if needed

Delivery is primary tx

29
Q

HELLP Syndrome prognosis ?

A

Majority of patients improve with prompt recognition and tx

30
Q

Exposure to Fetotoxic Agents: examples of teratogens ?

A

Viruses

Chemicals

Medications

31
Q

Exposure to Fetotoxic Agents: consider gestational age because organogenesis begins at ____ weeks

A

2-8

is the worst time! cause organ development

32
Q

Exposure to Fetotoxic Agents: difficult to predict outcome soo ?

A

council parents

Patient Evaluation (29 decks)

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