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Endo/Repro > Hypertensive Disorders in Pregnancy > Flashcards

Hypertensive Disorders in Pregnancy Flashcards

1
Q

What are some maternal risks for hypertensive disorders during pregnancy?

A
  • MI
  • Death
  • Cerebral vascular accident
  • Pulmonary edema
  • Renal and liver failure
  • Retinal ischemia and injury
  • Preeclampsia and eclampsia
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2
Q

What are some fetal complications with hypertensive disorders during pregnancy?

A
  • Fetal growth restriction
  • Preterm birth
  • Placental abruption
  • Stillbirth
  • Neonatal death
  • Congenital anomalies
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3
Q

What is chronic hypertension defined as?

A
  • Present before or recognized during first half of pregnancy
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4
Q

What is gestational hypertension defined as?

A
  • Recognized after 20 weeks gestation

- Or within 48-72 hours after delivery

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5
Q

What is preeclampsia hypertension defined as?

A
  • Occurs after 20 weeks and coexists with proteinuria
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6
Q

What is eclampsia hypertension defined as?

A
  • New onset seizure activity associated with preeclampsia
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7
Q

What is superimposed preeclampsia/eclampsia?

A
  • Transposed onto chronic hypertension
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8
Q

What are some possible causes of chronic hypertension?

A
  • Idiopathic
  • Vascular disorders
  • Endocrine disorders
  • Renal disorders
  • Connective tissue disorders
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9
Q

What are some vascular disorders that cause of chronic hypertension?

A
  • Reno-vascular

- Aortic coarctation

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10
Q

What are some endocrine disorders that cause of chronic hypertension?

A
  • Diabetes

- Hyperthyroidism

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11
Q

What are some renal disorders that cause of chronic hypertension?

A
  • Diabetic nephropathy

- Chronic renal failure

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12
Q

What is a connective tissue disorders that cause chronic hypertension?

A
  • Systemic lupus erythematosus
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13
Q

How do you take a BP?

A
  • After a patient has rested for at least 10 minutes and is seated with legs uncrossed and back supported
  • Use an appropriate sized cuff
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14
Q

What evaluation is done during assessment of chronic hypertension?

A
  • Rule out underlying disorders
  • Assess for maternal end-organ damage (CBC, CMP, 24 hour urine collection for total protein, EKG
  • Assess for fetal well being
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15
Q

What is being look at when assessing for fetal well being during chronic hypertension evaluation?

A
  • Initial ultrasound for accurate dating
  • Screening ultrasound
  • Growth ultrasounds monthly after 28 weeks gestation
  • Antepartum fetal testing to begin between 32-34 weeks gestation
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16
Q

What is the management for mild chronic hypertension?

A
  • Begin aspirin therapy 81 mg daily at 12 weeks till delivery
  • Initiate antihypertensives if reach threshold value
  • Prenatal visits every 2-4 weeks until 34-36 weeks gestation then weekly
  • Antepartum fetal monitoring
  • Delivery between 38-39+6 weeks gestation
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17
Q

What is the management for severe chronic hypertension?

A
  • Antihypertensive therapy (methyldopa, labetalol, nifedipine)
  • Avoid ACE inhibitors and ARBs due to increased risk of malformations
  • Close prenatal monitoring for medication dosage changes
  • With associated renal disease- 24 hour urine collection every trimester
  • Observation for signs of developing superimposed preeclampsia
  • Antepartum fetal surveillance
18
Q

When does gestational hypertension resolve?

A
  • By 12 weeks postpartum
19
Q

How is the diagnosis of preeclampsia made?

A
  • Hypertension
  • Proteinuria
  • Edema
20
Q

What are some symptoms of preeclampsia?

A
  • Scotoma
  • Blurred vision
  • Epigastric and/or RUQ pain
  • Headache
21
Q

What are some risk factors for preeclampsia?

A
  • Age (<20 and >35)
  • Nulliparity
  • Multiple gestation
  • Hydatidiform mole
  • Diabetes
  • Obesity
  • Chronic hypertension
  • Renal disease
  • Collagen vascular disease
  • Antiphospholipid syndrome
  • Prior history of preeclampsia
  • Assisted reproductive technology
  • Interpregnancy interval >7 years
  • Obstructive sleep apnea
22
Q

What happens in the brain during preeclampsia?

A
  • Cerebral edema

- Possibly fibrinoid necrosis, thrombosis, microinfarcts and petechial hemorrhages

23
Q

What happens in the heart during preeclampsia?

A
  • Absence of normal intravascular volume expansion

- Reduction in circulating blood volume

24
Q

What happens in the lungs during preeclampsia?

A
  • Noncardiogenic pulmonary edema
  • Changes in colloid osmotic pressure, capillary endothelial integrity and intravascular hydrostatic vessels (leaking vessels)
25
Q

What happens in the liver during preeclampsia?

A
  • Sinusoidal fibrin deposition in the periportal areas with surrounding hemorrhage and portal capillary thrombi
  • Stretching of glisson’s capsule results in RUQ pain
26
Q

What happens in the kidneys during preeclampsia?

A
  • Swelling and enlargement of glomerular capillary endothelial cells
  • Narrowing of the capillary lumen
27
Q

What happens in the eyes during preeclampsia?

A
  • Rential vasospasm

- Rential edema

28
Q

What does mild preeclampsia look like?

A
  • BP >140/90 but less than 160/110 at least 4 hours apart
  • Proteinuria >300 mg/24 hours or a single specimen urine protein:creatinine ration of 0.3mg/dL or a urine dipstick of +2
  • Asymptomatic
29
Q

What does severe preeclampsia look like?

A
  • BP systolic >160 or diastolic >110
  • Oliguria (less than 500 ml in 24 hrs)
  • Renal insufficiency
  • Liver enzymes twice the normal limits or epigastric pain refractory to treatment
  • Thrombocytopenia
  • Pulmonary edema
  • New onset headache
  • Symptomatic
30
Q

What is done during a preeclampsia evaluation?

A
  • Get complete history

- Address physical symptoms like headache, RUQ pain, N/V, vaginal bleeding, vision changes

31
Q

What does the PE look like in preeclampsia?

A
  • Brisk reflexes
  • Clonus
  • Edema
32
Q

What laboratory findings are seen in preeclampsia?

A
  • Increased Hct, lactate dehydrogenase, AST/ALT, and uric acid
  • Thrombocytopenia
33
Q

What is the management of preeclampsia without severe features at less than 37 weeks?

A
  • Once (BPP) or twice (NST) weekly antepartum testing
  • Fetal growth ultrasound every 3-4 weeks
  • Office visits and laboratory evaluation
  • Possibly hospitalization
34
Q

What is the management of preeclampsia without severe features between 37-40 weeks?

A
  • Begin induction at time of diagnosis at this gestational age
  • If favorable cervix - induction
  • If unfavorable cervix - use cervical ripening agent to begin induction
35
Q

What is the management of preeclampsia with severe features?

A
  • Immediate hospitalization
  • Delivery if greater than 34 weeks
  • Management of BP with anti-hypertensives (labetalol, nifedipine, hydralazine)
  • If less than 37 weeks, administer corticosteroids and work towards delivery as long as patient and fetus are stable
36
Q

What is the intrapartum management of preeclampsia?

A
  • Vaginal delivery is preferred
  • Use cervical ripening agents and pitocin if necessary
  • Magnesium sulfate administration for seizure prophylaxis
  • Pain management as with any delivery unless thrombocytopenic then may not be able to receive an regional anesthesia
37
Q

What is the loading dose and maintenance dose for magnesium sulfate?

A
  • 4 gm bolus for loading

- 2gm/hr for maintenance

38
Q

What is the therapeutic value for magnesium sulfate?

A
  • Between 5-9 mg/dL
39
Q

What is done in eclampsia?

A
  • Protect the airway
  • Magnesium sulfate administration is first line treatment
  • May need lorazepam if persistent
  • Not an indication for cesarean delivery but fetus may need some in-utero resuscitation time
40
Q

What is HELLP syndrome?

A
  • Hemolysis
  • Elevated liver enzymes
  • Low platelets
41
Q

What labs are seen in HELLP syndrome?

A
  • LDH greater than 600 IU/L
  • AST/ALT twice the upper limit of normal
  • Platelets less than 100,000
42
Q

What is done in HELLP syndrome?

A
  • Immediate delivery

Endo/Repro (31 decks)

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