Hypertensive Disorders of Pregnancy Flashcards
What are the types of HTN disorders in pregnancy? define them
chronic HTN: <20wks of >140/90
gestational HTN: >20wks of >140/90
preeclampsia: >20wk of >140/90 w/ end organ damage (protein)
HELLP syndrome: hemolysis, elevated liver enzymes, low platelets
what sort of lab values could indicate end-organ damage in preeclampsia?
- liver - elevated enzymes
- kidneys - renal insufficiency, elevated creatinine, protein in the urine
- thrombocytopenia
what s/s can we see in preeclampsia in severe cases?
Head area:
- new onset headache
- altered level of consciousness
- visual disturbances
- edema – specifically facial
Chest
- dyspnea/SOB - pulmonary edema
Abdo
- RUQ/epigastric pain - liver enlargement/damage from HELLP
General
- weakness/malaise - hemolytic anemia from HELLP
- peripheral edema in legs
- acute weight gain – as seen by the edema
- N/V/diarrhea
- hyperreflexia
what are some RFs to developing preeclampsia?
- extremes of age, >35Y and <20Y
- prepreg obesity
- T1DM, T2DM
- CVD
- Personal hx and FamHx of preeclampsia
- Multiple gestation
- Renal disease
- Autoimmune disease
- hx of adverse preg outcome
explain the general pathophys of how preeclampsia occurs
- Abnormal trophoblastic invasion of spinal arteries (shallow)
- placental hypoperfusion
- release of systemic vasoactive compounds
- exaggerated inflammatory response
- vasoconstriction and endothelial damage
- renal hypoperfusion
- activated RAAS
- increase in BP
explain the general pathophys of how HELLP syndrome occurs
- Endothelial injury
- microthrombi → consumptive uses of platelets ➔ low platelets
- Microthrombi disrupts blood flow → sheer stress → damaged RBCs → hemolysis
- Hypertension affecting liver → damage to hepatocytes → elevated liver enzymes
how is preeclampsia/HTN disorders usually diagnosed?
during a routine prenatal visit
1. vitals ➔ BP measurement
2. urine analysis ➔ dipstick (+ proteins), 24h collection for total protein (gold standard), other: random spot for protein or protein/albumin to creatinine ratio
3. bloodwork
- CBC
- electrolytes
- liver enzymes
- hemolytic - LDH
- bilirubin
- albumin
- creatinine and urea
- PT/INR
- fibrinogen
what s/s would you expect to see in HELLP syndrome?
low plts
- petechiae, ecchymosises, purpura
elevated liver enzymes
- RUQ pain
hemolytic anemia
- fatigue/malaise
- hepatosplenomegaly
what sort of prevention measures would you tell a preg pt to do to prevent preeclampsia
- calcium supplementation
- low dose aspirin
- educate pt on exercise and low stress
- consider LMWH if pt has hx of obstetric cx
how do we manage nonsevere preeclampsia?
- first line is a BB (labetalol), or a CCB or alpha-methyldopa
- second line is diuretic or vasodilator which require more monitoring
how do we manage severe preeclampsia with pts who are in a htn emergency?
- admit
- IV antihypertensives - BB + vasodilator
- tx s/s ➔ be cautious with fluids because of risk of pulmonary edema
- if mom is not responding and may seize, give IV magnesium sulfate for neuroprotection
- if mom is not responding, prepare for delivery
- antenatal corticosteroids for preterm delivery within 7 days to help mature fetus lungs
