Hypertensive Disorders Of Pregnancy Flashcards
A 25-year-old, married, gravida-2, patient who has had two live births
presented to a health center with the chief compliant of abnormal body
swelling of 2 days’ duration and loss of consciousness. On arrival to the
first contact student health center her blood pressure was 170/105
mmHg and her temperature was 36.5 °C. She had generalized swelling, a
history of blurred vision, and headache. She had no history of abortion,
stillbirth, and cesarean section and no history of antenatal care follow-
up. The gestational age at the time of arrival was 37 weeks. She was
referred to a OHSU for further management.
At the OHSU she was diagnosed as having severe preeclampsia and she
was managed with magnesium sulfate and an antihypertensive
medication for 2 days. She was counseled to have induction of labor by
the attending physician but refused to give consent and went home. She
returned to the OHSU 2 days later after labor had started spontaneously
at home and the delivery was complicated.
What do we know?
What do you expect the providers to order for this patient for her blood
pressure?
New onset HTN, 37 wks pregnant
Hydrazine, labetalol
HPT affects ____ to ____ of pregnancies
It is a leading cause of maternal mortality
5-10%
Define chronic HPT
BP over 140/90 on 2 diff occasions before 20 wks of gestation or after 12 wks
Define gestational HPT
BP over 140/90 after 20 wks of gestation
Define superimposed HPT
Worsening of HPT and development of new-onset proteinuria after 20 wks of gestation
Define preeclampsia
BP 140/90 and proteinuria or end-organ diseases after 20 wks of gestation
A 29-year-old woman gravida 3, para 2 presents at 29 weeks’ gestation with a chief complaint of frequent
urination. You note pitting ankle edema on her physical examination. Her urine is 1+ for protein, and her
blood pressure is 180/100 mm Hg. Her past medical history is unremarkable. Three months ago her blood
pressure was 125/70 mm Hg. What is the most likely diagnosis?
A. patient is normal for this stage of pregnancy
B. chronic hypertension
C. preeclampsia
D. gestational hypertension
E. preeclampsia superimposed on chronic hypertension
c
What are risk factors for developing preeclampsia?
Preexisting HPT
Diabetes
CKD
Obesity
Maternal age over 35
Genetic predisposition
Why does preeclampsia occur?
Not well known, it is a placental disease. Caused by immunological factors, preexisting factors, and genetic factors. It could be due to reduced placental perfusion causing vasospasm, systemic vascular dysfunction, and capillary leaks.
What does preeclampsia cause?
What is the treatment o f choice for seizures of eclampsia?
Angiotensin II sensitivity
HPT
Coagulation abnormalities (HELLP syndrome)
Cerebral edema (eclampsia)
Proteinuria
Glomerular endotheliosis
Magnesium sulfate
*preeclampsia causes constricted blood flow through arteries
A 26-year-old G3P2 woman at 31 4/7 weeks gestation presents to the clinician with complaints of headache,
blurred vision, shortness of breath, and epistaxis. Her pulse was at 92/min while her blood pressure was at
156/100 mmHg. She had a history of two fetal demises in the past, occurring at the 25th and 28th weeks of
pregnancy, respectively. On examination, mild +1 edema is noted in bilateral lower extremities. The urine
protein to creatinine ratio is 0.37. Which presenting symptom is of most concern in this patient?
A. Vomiting
B. Heartburn
C. Visual disturbances
D. Mild edema
c because of CNS involvement
What glomerular damage does preeclampsia cause?
Increased plasma Uric acid and creatinine
Oliguria
what cerebral vasospasms are casused by preeclampsia?
HAs
Hyper reflex is
Seizures
What retinal arteriolar spasms are caused by preeclampsia?
Blurred vision and scotoma
