Hypertensive Disorders In Pregnancy Dr. Wootton

Question 1

1. Chronic HTN
2. Gestational HTN
3. Preeclampsia
4. Eclampsia

Answer 1

1. Preexisting , comes 1st half, persists 12 weeks postpartum
2. After 20 weeks gestation
3. After 20 weeks + proteinuria
4. Preeclampsia + new onset seizures

Question 2

Growth US deon when , Antepartum fetal testing done when in chronic HTN mother

Answer 2

1. Every month after 28 weeks

2. 32-34 weeks start

Question 3

Mild hypertension

1. BP is what
2. Tx
3. What do you do

Answer 3

1. Under 160/110
2. Start 81mg baby aspirin at 12 weeks
   Hypertensive therapy if at 160/110
3. Prenatal visit 2-4 weeks until 36 weeks, antepartum monitoring, deliver at 38-39 weeks

Question 4

Severe HTN

1. BP is what
2. Tx
3. What do you do
4. What to avoid **

Answer 4

1. Over 160/110
2. Give antihypertensive therapy (Methyldopa bad, Labetalol, Nifedipine) and others
3. Continue same fetal monitoring every 3-4 weeks with stress tests + , 24hr urine collection every trimester + look for preeclampsia + deliver at 37-39 weeks
4. AVOID ACEI + ARBs, = renal dysgenesis, calvarial hypoplasia, fetal growth restriction

Question 5

Gestational HTN

1. Definition it needs to have

Answer 5

1. No preeclampsia features

2. After 20 weeks, or within 48-72 hours after delivery , resolves before 12 weeks postpartum

Question 6

Preeclampsia

1. SX
2. DX

Answer 6

1. proteinurea, HTN, edema can happen

2. Scotoma, blurred vision, Epigastic and RUQ pain, HA

Question 7

Risk of preeclampsia

Answer 7

1. Age under 20, over 40
2. 1st baby
3. Multigestation
4. DM, obesity BMI over 30, chronic HTN, renal disease
5. SLE
6. Antiphospholipid syndrome
7. AA
8. Prior history *, assisted reproductive technology

Question 8

Brain, heart, lungs in preeclampsia

Answer 8

1. Brain = due to cerebral edema HA, fibroid necrosis, thrombosis, microinfarcts, petechiae hemorrhages
2. Heart = absence of normal intravascular Blood volume, FALSE ELEVATED Hb AND Hct*
3. Lungs = Pulmonary edema not due to heart, colloid osmotic P changes, = LEAKY BVs

Question 9

Liver, Kidney, eyes in preeclampsia

Answer 9

1. Liver : RUQ pain, sinusoidal fibrin deposition in periportal areas with surrounding hemorrhage + Portal cap thrombi(subcapsular hematoma—> Liver rupture) PAIN when GILSONS capsule expands
2. Kidney : proteinuria, edema = glomerular cap endothelial cells swell ——> narrowing capillary lumen
3. Eyes : retinal vasospasm, retinal edema

Question 10

Mild preeclampsia (Preeclampsia without severe features) 3 things it needs

Answer 10

1. Over 140/90, less then 160/110 at least 4 hours apart
2. Proteinuria over 300mg/24hr**, urine Protien : Cr = 0.3mg/dL *
3. Asymptomatic

Question 11

Severe preeclampsia (preeclampsia with severe features)

Answer 11

1. BP is over 160/110 2 times and 4 hours apart
2. Oligouria (less then 500ml/24hr, serum CR over 1.1 or doubling from baseline **
3. Liver Enzymes 2x upper limit, OR Epigastric Pain even after tried tx (RUQ pain)
4. Pulm edema
5. Low pts (thrombocytopenia )
6. HA NOT RELIEVED WITH MEDS

Question 12

Severe preeclampsia PE findings and labs findings

Answer 12

1. Brisk reflex, clones at least 3 per dorsiflextion, edema

2. .high hct, lactate dehydrogenase, AST/ALT, Uric Acid + Low plt

Question 13

Managing MILD Preeclampsia if under 37 weeks

Answer 13

1. Weekly BPP 1 time and NST 2 times (Biophysical profiles, non stress test)
2. Fetal US every 3-4 weeks
3. Labs + office visit 1 time a week

Question 14

Managing MILD Preeclampsia if at 37 weeks or over

Answer 14

Begin induction at time of DX,

1. if cervix is favorable = induce with pitocen
2. Cervix is not favorable = cervical ripening with cervidel

Question 15

Managing SEVERE Preeclampsia

Answer 15

1. Immediate hospitalization
2. Deliver if at 34 weeks
3. Antihypertensives (Labetalol, Nifedipine)
4. Corticosteroids (dexamethasone or beatmethasone) if under 37 weeks to work towards delivery = decrease intracranial hemorrhage and stabilize BVs

Question 16

1. Magnesium Sulfate is used for

2. When can you not give pain management of regional anesthesia

Answer 16

1. Seizures prophylaxis in preeclampsia pt

2. Thrombocytopenia present in preeclampsia

Question 17

Mg sulfate

1. Risk it has
2. Monitor how
3. REVERSE how

Answer 17

1. Fluid overload, restrict fluid, resp paralysis, cardiac arrest, loss of patellar reflex (1st sign that dose is too high) between 4-6 ideal not above 7
2. Check every hour, continue 24hr after delivery
3. Calcium Gluconate

Question 18

Eclampsia

1. What
2. What should i do first
3. Tx

Answer 18

1. New onset tonic clinic seizures (1-2 min) most occurs within 24hr of delivery
2. Protect airway
3. Give Mg Sulfate, lorazepam if persistent

Question 19

HELLP Syndrome is what and stands for

Answer 19

Variant of preeclampsia

1. Hemolysis,
2. Elevated Liver enzymes,
3. Low Plt

= 50% eclampsia pts, 4-12% preeclampsia pt

Question 20

Labs in HELLP syndrome + TX what to do

Answer 20

1. LDH over 600
2. AST/ALT 2x upper limit
3. Plt under 100,000
   HTN and protienuria is variable

= DELIVER IMMEDIATELY

Question 21

What can you do to prevent preeclampsia

Answer 21

Aspirin if pt has risk factors

Question 22

Urine dip stick should be what to be diagnostic for preeclampsia
+ severe features can be what

Answer 22

+ 2
(Use 160/110, however with abnormal lab findings and Neurologic sx = Severe OR vision change for example or HA without med relief, or Cr over 0.3mg, THEN if at 28weeks and you cant deliver her give corticosteroids and use Mg sulfate to prevent cerebral palsy if EM deliver needs to happen anyway, give antihypertensive also)