Hypertensive Disorders Of Pregnancy Flashcards

1
Q

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?

A

New onset HTN, 37 wks pregnant
Hydrazine, labetalol

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2
Q

HPT affects ____ to ____ of pregnancies
It is a leading cause of maternal mortality

A

5-10%

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3
Q

Define chronic HPT

A

BP over 140/90 on 2 diff occasions before 20 wks of gestation or after 12 wks

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4
Q

Define gestational HPT

A

BP over 140/90 after 20 wks of gestation

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5
Q

Define superimposed HPT

A

Worsening of HPT and development of new-onset proteinuria after 20 wks of gestation

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6
Q

Define preeclampsia

A

BP 140/90 and proteinuria or end-organ diseases after 20 wks of gestation

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7
Q

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

A

c

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8
Q

What are risk factors for developing preeclampsia?

A

Preexisting HPT
Diabetes
CKD
Obesity
Maternal age over 35
Genetic predisposition

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9
Q

Why does preeclampsia occur?

A

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.

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10
Q

What does preeclampsia cause?
What is the treatment o f choice for seizures of eclampsia?

A

Angiotensin II sensitivity
HPT
Coagulation abnormalities (HELLP syndrome)
Cerebral edema (eclampsia)
Proteinuria
Glomerular endotheliosis

Magnesium sulfate

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11
Q

*preeclampsia causes constricted blood flow through arteries

A
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12
Q

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

A

c because of CNS involvement

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13
Q

What glomerular damage does preeclampsia cause?

A

Increased plasma Uric acid and creatinine
Oliguria

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14
Q

what cerebral vasospasms are casused by preeclampsia?

A

HAs
Hyper reflex is
Seizures

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15
Q

What retinal arteriolar spasms are caused by preeclampsia?

A

Blurred vision and scotoma

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16
Q

what are the symptoms of liver ischemia caused by preeclampsia?

A

Elevated liver enzymes
N/V
Epigastric pain
RUQ pain

17
Q

Diagnosis of preeclampsia:
BP?
Proteinuria?
Kidney function?

A

Over140/90
Urine protein 1+ or more, protein > 300mg in 24 hours, protein/creatinine ratio > 0.3g
Serum creatinine > 1.1mg/dL

18
Q

Features of severe preeclampsia?

A

BP over 160/110
Platelet count decreasing < 100,000
Impaired liver function
Serum creatinine continues increasing > 1.1
Pulmonary edema
New onset visual disturbances or RUQ pain

19
Q

What are fetal effects of preeclampsia?

A

Hypoperfusion of placenta
Prematurity

20
Q

Maternal effects of preeclampsia?

A

CVD
Metabolic syndrome
Peripartum cardiomyopathy
End-stage renal disease

21
Q

Best med for managing BP during pregnancy? other drug classes?

A

Labetalol
CCBs
NSAIDs
Antiadrenergics

22
Q

What Qs should I ask a pregnant pt at every visit?

A

HAs?
Visual changes?
Epigastric pain?
Fetal movement?
Swelling?

23
Q

What is the antidote for magnesium sulfate?

A

Calcium gluconate

24
Q

What is the MoA of magnesium sulfate?
What are the interactions?

A

Decreases plasma endothelin-1 which protects the vascular endothelial cells and causes cerebral arterial vasodilation which may relieve cerebral ischemia

Potentials B-blockers, increases potency of nondepolarizing muscle relaxants, decreases platelet activity

25
Q

A 35-year-old G3P0200 at 29 2/7 weeks gestation presents to the clinician with complaints
of headache, blurred vision, shortness of breath, and nose bleed. Her pulse was at 89
beats/minute while her blood pressure was at 150/100 mmHg. She had a significant
obstetric history of 2 fetal demises in the past that occurring at the 25th and 28th weeks of
pregnancy, respectively. On examination, her sclerae are noted to be slightly yellow, with +2
edema in her hands and bilateral lower extremities. A urine dipstick test was positive for
proteinuria. During the evaluation, the patient begins to exhibit the signs and symptoms of
an active seizure episode for the last 5 minutes. Which drug is the most appropriate to
initiate at this time?

A. Carbamazepine
B. Kepper IV
C. Magnesium sulfate
D. Lorazepam IV
E. Phenytoin IV

A

c

26
Q

How is labetalol dosed?
Avoid in pts w/?

A

IV 200-1200mg in 2/3 divided doses
Asthma or bradycardia

27
Q

Action of hydralazine?
Dosing?
Max dose?
Adv. Rxn?

A

Peripheral vasodilation and increase cardiac output and HR
5mg IV or 10mg IM… 5-10mg every 20-30 min
20mg IV or 30mg IM
Rebound tachycardia and HPT

28
Q

Dosing of nifedipine?
SEs?

A

30-120mg IV
Flushing, peripheral edema, reflex tachycardia, and HA

29
Q

Use of methyldopa?
Dosing?
SEs?

A

Reduce BP
250-800mg PO q8h
HAs, flushing, tachycardia

30
Q

How to prevent preeclampsia?

A

ASA 150mg/day
Calcium 1.5-2g

31
Q

A 23-year-old woman who is 35 weeks pregnant presents in acute respiratory failure
secondary to tonic-clonic seizures. She has a history of anemia and preeclampsia. On
physical examination, her blood pressure is 170/110 mm Hg. Which of the following
statements is true about eclampsia?

A. Beta blockers are contraindicated in pregnant patients because they may induce
labor.
B. Intravenous diazepam is recommended for seizure control.
C. Eclampsia will always include seizures.
D. The maternal death rate is approximately one in 10.
E. Its incidence is approximately one in 400.

A

C

32
Q

How can magnesium effect the fetus?

A

May cause decreased variability on the fetal heart and decreased activity at birth

33
Q

What should the pt be constantly monitored for during pregnancy?

A

HELLP syndrome: hemolysis, elevated liver enzymes, and low platelets