Hypertensive Disorders of Pregnancy

Question 1

new onset of hypertension and either proteinuria or end-organ dysfunction after 20 weeks of gestation in a previously normotensive woman

Answer 1

preeclampsia

Question 2

the development of grand mal seizures in a woman with preeclampsia, in the absence of other neurologic conditions that could account for the seizure

Answer 2

eclampsia

Question 3

What does HELLP stand for?

Answer 3

Hemolysis, Elevated Liver enzymes, Low Platelets

Question 4

systolic pressure ≥140 mmHg and/or diastolic pressure ≥90 mmHg that antedates pregnancy or is present before the 20th week of pregnancy (on at least two occasions) or persists longer than 12 weeks postpartum

Answer 4

chronic/preexisting HTN

Question 5

hypertension without proteinuria or other signs/symptoms of preeclampsia that develops after 20 weeks of gestation. It should resolve by 12 weeks postpartum

Answer 5

gestational HTN

Question 6

Risk factors of preeclampsia

Answer 6

past personal h/o or family h/o, nulliparity, twin pregnancies, advanced maternal age, CKD, DM, HTN, obese

Question 7

results in complete resolution of signs and symptoms of preeclampsia, with some symptoms disappearing in a matter of hours (eg, headache), while others may take months (eg, proteinuria)

Answer 7

delivery of the placenta

Question 8

what serious maternal and/or fetal sequelae can be associated with preeclampsia?

Answer 8

abruptio placentae; liver hematoma or rupture; disseminated intravascular coagulation; stroke

Question 9

organ most likely to manifest endothelial injury related to preeclampsia

Answer 9

the kidney

Question 10

Definition of proteinuria in preeclampsia

Answer 10

≥0.3 grams protein in a 24-hour urine specimen or persistent 1+ (30 mg/dL) on dipstick

Question 11

Expected effect of preeclampsia on GFR

Answer 11

decreased by 30-40%

Question 12

most common coagulation abnormality in preeclampsia

Answer 12

thrombocytopenia

Question 13

Platelet count that elevates preeclampsia from mild to severe

Answer 13

<100,000

Question 14

Expected effect of preeclampsia on prothrombin time, partial thromboplastin time, and fibrinogen concentration

Answer 14

not affected unless accompanied by abruptio placentae or severe liver dysfunction

Question 15

clinical manifestations of hepatic dysfunction that upstage preeclampsia from mild to severe

Answer 15

RUQ or epigastric pain, elevated transaminases, coagulopathy

Question 16

Description of epigastric pain associated with preeclampsia

Answer 16

severe constant pain that begins at night, maximal in the low retrosternum or epigastrium, may radiate to the right hypochondrium or back

Question 17

Why does severe preeclampsia present with epigastric pain?

Answer 17

stretching of Glisson’s capsule due to hepatic swelling or bleeding

Question 18

Cause of blurred vision, flashing lights or sparks (photopsia), and scotomata (dark areas or gaps in the visual field) in severe preeclampsia

Answer 18

constriction of retinal arteries

Question 19

fetal consequences of chronic placental hypoperfusion

Answer 19

fetal growth restriction and oligohydramnios

Question 20

What is the next step if dipstick is 1+ proteinuria?

Answer 20

24 urine collection or protein:creatinine ratio

Question 21

What should the minimum post-diagnostic laboratory/imaging evaluation of preeclampsia include?

Answer 21

plt count, serum Cr, AST/ALT, Obstetrical ultrasound (fetal weight, amniotic fluid volume), Fetal assessment (biophysical profile or nonstress test)

Question 22

optimum management for women with preeclampsia without features of severe disease at ≥37 weeks of gestation

Answer 22

delivery

Question 23

Why are antihypertensives not used in management of preeclampsia with BP <150/110?

Answer 23

Lowering BP doesn’t affect the course of preeclampsia because the primary pathogenetic process is an abnormality of the placental vasculature that results in placental underperfusion, which leads to release of factors that cause widespread maternal endothelial dysfunction with multiorgan dysfunction

Question 24

In the setting of severe HTN in preeclampsia (BP >160/110) or expectant management of preeclampsia with severe features, what are first-line agents for acute therapy?

Answer 24

labetolol or hydralazine (IV)

Question 25

good option for treatment of hypertension associated with pulmonary edema

Answer 25

nitroglycerin

Question 26

How long should a woman with preeclampsia be admitted to the hosptial for?

Answer 26

48 hours. transferred to less intensive care when her BP is stable, her laboratory tests are stable or improving, and fetal testing is reassuring.

Question 27

During initial management of preeclampsia what medication should be administered to mother for seizure prophylaxis

Answer 27

magnesium sulfate

Question 28

During initial management of preeclampsia what medication should be administered to mother to enhance fetal lung maturity

Answer 28

betamethasone

Question 29

How often should BP be monitored in preeclampsia during intitial management?

Answer 29

every 2 hrs

Question 30

How long should magnesium sulfate be continued?

Answer 30

until completion of the course of antenatal corticosteroids