Hypertensive disorders in pregnancy- Wootton

Question 1

what is the definition of hypertension in preggo

Answer 1

sustained blood pressure higher than 140/90

Question 2

what is gestational HTN?

Answer 2

recognized after 20 weks gestation, without proteinuria, resolves 12 weeks post partum

Question 3

what do you do to asses the fetus of a mother with chronic hypertension?

Answer 3

must asses for well being- initial ultrsound to date accuratly, get growth ultrasounds monthly after 28 weeks gestation

Question 4

what is mild HTN? and how do you manage?

Answer 4

less than 160/100

delivery at 39-40 weeks

Question 5

what is the first line for anti HTN drugs in preggos?

Answer 5

methyldopa, can also use nifedipine, labetolol, hydralazine

Question 6

what HTN medication is contrindicated in pregnancy?

Answer 6

ACE-inhibitors

Question 7

what is the management of severe chronic HTN?

Answer 7

close monitoring, urine collection every trimester with renal disease, antepartum growth ultrasounds, delivery at 38 weeks, or with fetal lung maturity

Question 8

what are teh major symptoms of pre eclampsia?

Answer 8

hypertension, proteinuria, (edema), headache

Question 9

what are some risk factors for pre eclampsia?

Answer 9

age ( under 20 or over 35), multiple gestation, hydatitiform mole,

Question 10

what are the findings in pre eclampsia?

Answer 10

cerebral edema, reduction in circulting blood volume, third spacing , non cardiogenic pulmonary edema ( changes in colloid osmotic pressure, can get liver rupture due to subscapular hematoma

Question 11

what is the diagnopsis for severe pre eclampsia?

Answer 11

systolic BP over 160, diastolic over 110, on 2 occassions , 6 hours apart, 5 grams of protein in urine /24 hours, or 3+ protein on 2 random urine dips

Question 12

does tylenol help the symptoms of pre eclampsia?

Answer 12

NO

Question 13

what are some findings on physical for pre eclampsia?

Answer 13

brisk refelexes, , clonus, increased hematocrit, LDH, AST/ALT, uric acid

Question 14

what are the measures to manage severe pre eclampsia?

Answer 14

immediate hospitalization, if greater than 34 weeks, deliver, give antihypertensives ( hydralizine, labetelol) if less than 34 weeks, give steroids to help lung development to get the baby out

Question 15

what is the prefered method of birthing?

Answer 15

vaginal delivery, can use pitocin ( cervical ripening) if needed, also give magnesium sulfate for siezure prophylaxis

Question 16

when would a woman NOT be able to get an epidural?

Answer 16

when they have thrombocytopenia

Question 17

what is eclampsia? how do you manage it?

Answer 17

siezure that lasts for 1-2 minutes, manage by diazepam, larazepam, Mg sulfate, dont get the baby out imediatly, allow the baby time to get back to normal in the uterus before you get it out

Question 18

what is HELLP syndrome?

Answer 18

variant of pre eclmampsia, hemolysis, elevated liver enzymes, low platelets ,
will present with RUQ pain, can also have epigastric pain, and nausea/ vomitting

Question 19

is there a proven traetment for HELLP?

Answer 19

NO- asprin and calcium are given now

Question 20

woman has BP of 106/64 and 2+ pitting edema, no clonus, and normal reflexes, normal labs, whats teh Dx?

Answer 20

physiological anemia

Question 21

38 year old at 38 weeks presents and has BP 158/90 urine dip is 1+, this is a new finding, what would you do? if the patient later has hypersensitive relfexes, urine dip 2+ for protein, three beats of clonus, and low platlets, whats the DX?

Answer 21

recheck the BP and urine Dip-

DX for second part= HELLP syndrome

Question 22

woman presents with headaches that are inrelieved by tylenol for three days, vision is blurred, no epigastric pain, or nausea/vomitting, BP= 155/98, labs normal except 24 urine = 5500mg, fetus is severey growth restricted at 28 weeks, DX? management?

Answer 22

SEVERE pre eclampsia

give steroids to improve fetal outcome ( lung maturity)