Hypertensive Disorders in Pregnancy Flashcards
What is gestational HTN?
When does it occur? (2)
When does it resolve?
True diagnosis is made…
HTN without any of preeclampsia
After 20 weeks gestation OR within 48-72 hrs. after delivery
Resolves by 12 weeks postpartum
True diagnosis is made in retrospect
What is superimposed preeclampsia/eclampsia?
Preeclampsia/eclampsia transposed onto chronic HTN
Which 2 measures should be taken when taking BP?
Have patient rest for at least 10 min and sit with legs uncrossed and back supported.
Use a cuff that is 1.5x the upper arm circumference.
What 4 things should be done in a pregnant woman with chronic HTN?
Initial US for accurate dating
Screening US
Growth US monthly after 28 weeks gestation
Antepartum fetal testing between 32-34 weeks gestation
What therapy is used for mild HTN (<160/110)?
When is delivery?
Aspirin therapy at 81 md/daily at 12 weeks until delivery
Delivery between 39-40 weeks gestation
What are some anti-hypertensive drugs used in severe HTN in pregnancy (>160/110)?
Methyldopa
Labetalol*
Nifedipine*
What drugs are contraindicated in pregnancy?
What do they cause?
ACE-inhibitors and ARBs
Increased risk of malformations (renal dysgenesis, calvarial hypoplasia and FGR)
In a patient with severe HTN and associated renal disease, what is done to monitor it?
24-hr. urine collection every trimester
What kind of antepartum fetal surveillance is done in a pregnant woman with severe HTN? (2)
When is delivery?
Growth US every 3-4 weeks
Non-stress tests and/or biophysical profiles
Delivery after 38 weeks gestation
What is needed for a diagnosis of preeclampsia?
What are some symptoms? (4)
HTN, proteinuria, possible edema
Scotoma, blurred vision, epigastric or RUQ pain, HA
What happens in the brain in preeclampsia mainly? What is the main symptom?
What else is possible?
Cerebral edema; HA
Possible fibrinoid necrosis, thrombosis, micro-infarcts and petechial hemorrhages
What happens in the heart in preeclampsia?
What is the main symptom?
Third spacing and reduction in circulating blood volume; edema
What happens in the lungs in preeclampsia?
What is the main symptom?
Non-cardiogenic pulmonary edema; pulmonary edema
What happens in the liver in preeclampsia?
What is the main symptom?
Sinusoidal fibrin deposition in periportal areas with surrounding hemorrhage and portal thrombi; RUQ pain
What happens in the kidneys in preeclampsia?
What is the main symptom?
Swelling and enlargement of the glomerular endothelial cells and narrowing of the lumen; proteinuria/edema
What happens in the eyes in preeclampsia?
What is the main symptom?
Retinal changes and retinal edema; vision changes
What is the BP in mild preeclampsia?
What is the proteinuria?
What is the symptomatology?
BP = 160/110>X>140/90
Proteinuria > 300 mg/24 hrs, but < 5 g/24 hrs., or single specimen urine protein:creatinine of 0.3
Asymptomatic
What are features of severe preeclampsia?
BP > 160 systolly, or > 110 diastolly
Proteinuria > 5 g/24 hrs. or 3+ protein on 2 random urine dips at least 4 hrs. apart
Cerebral or visual changes Pulmonary edema Epigastric/RUQ pain Elevated LFTs Thrombocytopenia
What are 2 findings on exam in a patient with preeclampsia?
Brisk reflexes/clonus
Possible edema
What lab findings are noticed in preeclampsia? (5)
Increased: Hct, LDH, AST/ALT, uric acid
Thrombocytopenia
Management of mild preeclampsia if < 37 weeks gestation may include: (4)
Once (PPP) or twice (NST) weekly antepartum testing
Fetal growth US every 3-4 weeks
Office visits and lab eval.
Possible hospitalization
What should be done to the cervix in mild HTN from weeks 37-40 gestation?
If favorable, induce cervix.
If unfavorable cervix, use a ripening agents to begin induction.
At what point should delivery be considered if the mom become preeclamptic with severe features?
What else should be done? (2)
If > 34 weeks
Immediate hospitalization and management of BP medically
Magnesium sulfate is indicated for…
What is the loading dose for preeclampsia?
What is the maintenance dose for preeclampsia?
What is the therapeutic value?
What happens if too much is given?
How long is it continued for?
Preeclampsia with severe features for seizure prophylaxis
Loading dose: 4 g bolus Maintenance: 2 g bolus Therapeutic value: 5-9 g/dl ->9 loss of patellar reflexes ->12 respiratory paralysis ->30 cardiac arrest
If overloaded, respiratory and cardiac arrest (calcium gluconate is given to reverse course)
Continue for 24 hrs. post delivery
What should be done first in eclampsia?
What is the 1st line treatment?
Protect airway
Magnesium sulfate (may need lorazepam if persistent)
HELLP syndrome includes:
Symptoms (3)
What must be done if this presents?
Hemolysis, elevated liver enzymes and low platelet count (variant of preeclampsia)
RUQ pain, epigastric pain, N/V
Immediate delivery
