Hypertensive Disorders of Pregnancy Flashcards
Concurrent pregnancy and hypertension consists of … (2)
- Chronic hypertension
- Chronic hypertension with superimposed preeclampsia
Pregnancy induced hypertension (PIH) consists of … (2)
- Gestational hypertension
- Preeclampsia / eclampsia
Describe chronic hypertension
BP ≥ 140 / 90 before pregnancy
______ is essential for chronic hypertension
Early prenatal care
Describe the management of chronic hypertension during pregnancy (5)
- labetolol (not harmful to fetus)
- Limit sodium
- Fetal monitoring
- BP monitoring
- Bedrest
Describe gestational hypertension (3)
- Transient BP ≥ 140 / 90
- BP elevation for the first time mid-pregnancy
- BP may return to normal by 12 weeks postpartum
If a patient with gestational hypertension does not return to normal by 12 weeks postpartum …
Possible diagnosis of chronic hypertension - further evaluation required
Describe chronic hypertension with superimposed preeclampsia
Preeclampia develops in women with a history of chronic hypertension
Describe preeclampsia (2)
- BP ≥ 140 / 90 after 20 weeks gestation
- Proteinuria / edema (toxemia)
Describe eclampsia (2)
- Seizure occurance secondary to preeclampsia
- May occur before / during / after labor
What are the risk factors of preeclampsia? (6)
- First pregnancy
- First pregnancy with a new partner
- First pregnancy in 10 years or more
- Chronic hypertension
- Kidney disorders
- Diabetes
Describe the pathophysiology of preeclampsia (3)
- Abnormal prostaglandin production
- Exaggerated inflammatory response
- Increased sensitivity to angiotensin II causes vasospasms
What is the only cure for preeclampsia?
Birth of the fetus and removal of the placenta
What are the effects of systemic vasospasms seen in preeclampsia? (2)
- Decreased perfusion to target organs
- Large protein molecules cause extracellular swelling
Describe the vascular changes associated with preeclampsia (3)
- Increased hematocrit
- Decreased plasma volume
- Disrupted glomerular filtration - proteinuria
What BP is associated with mild preeclampsia?
BP ≥ 140 / 90 (systolic increase of 30 / diastolic increase of 15)
What assessment findings are present in mild preeclampsia? (3)
- Proteinuria ≥ 1+
- Edema in face / hands
- Weight gain ≥ 5 lbs / week
What BP is associated with severe preeclampsia?
BP ≥ 160 / 110 (2 readings 6 hours apart)
What assessment findings are present in severe preeclampsia? (2)
- Proteinuria ≥ 2+
- Oliguria ≤ 30 ml / hr
What are the manifestations of severe preeclampsia? (5)
- RUQ pain
- Restricted fetal growth
- Impaired liver function
- Pulmonary edema
- Thrombocytopenia
Describe the neonatal risks associated with severe preeclampsia (3)
- Prematurity
- Placental abruption
- Small size - hypoxia / hypovolemia
Describe the functions of magnesium sulfate (MgSO4) in pregnancy (4)
- Relaxes uterine muscles / blood vessels
- Decreases BP
- Delays preterm labor
- Prevents seizures
What types of seizures occur during eclampsia? (3)
- Focal
- Multifocal
- Generalized
Describe the characteristics of HELLP syndrome (3)
- Hemolysis
- Elevated liver enzymes
- Low platelets
