Hypertensive Disorders of Pregnancy Flashcards
new onset of hypertension and either proteinuria or end-organ dysfunction after 20 weeks of gestation in a previously normotensive woman
preeclampsia
the development of grand mal seizures in a woman with preeclampsia, in the absence of other neurologic conditions that could account for the seizure
eclampsia
What does HELLP stand for?
Hemolysis, Elevated Liver enzymes, Low Platelets
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
chronic/preexisting HTN
hypertension without proteinuria or other signs/symptoms of preeclampsia that develops after 20 weeks of gestation. It should resolve by 12 weeks postpartum
gestational HTN
Risk factors of preeclampsia
past personal h/o or family h/o, nulliparity, twin pregnancies, advanced maternal age, CKD, DM, HTN, obese
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)
delivery of the placenta
what serious maternal and/or fetal sequelae can be associated with preeclampsia?
abruptio placentae; liver hematoma or rupture; disseminated intravascular coagulation; stroke
organ most likely to manifest endothelial injury related to preeclampsia
the kidney
Definition of proteinuria in preeclampsia
≥0.3 grams protein in a 24-hour urine specimen or persistent 1+ (30 mg/dL) on dipstick
Expected effect of preeclampsia on GFR
decreased by 30-40%
most common coagulation abnormality in preeclampsia
thrombocytopenia
Platelet count that elevates preeclampsia from mild to severe
<100,000
Expected effect of preeclampsia on prothrombin time, partial thromboplastin time, and fibrinogen concentration
not affected unless accompanied by abruptio placentae or severe liver dysfunction
clinical manifestations of hepatic dysfunction that upstage preeclampsia from mild to severe
RUQ or epigastric pain, elevated transaminases, coagulopathy
Description of epigastric pain associated with preeclampsia
severe constant pain that begins at night, maximal in the low retrosternum or epigastrium, may radiate to the right hypochondrium or back
Why does severe preeclampsia present with epigastric pain?
stretching of Glisson’s capsule due to hepatic swelling or bleeding
Cause of blurred vision, flashing lights or sparks (photopsia), and scotomata (dark areas or gaps in the visual field) in severe preeclampsia
constriction of retinal arteries
fetal consequences of chronic placental hypoperfusion
fetal growth restriction and oligohydramnios
What is the next step if dipstick is 1+ proteinuria?
24 urine collection or protein:creatinine ratio
What should the minimum post-diagnostic laboratory/imaging evaluation of preeclampsia include?
plt count, serum Cr, AST/ALT, Obstetrical ultrasound (fetal weight, amniotic fluid volume), Fetal assessment (biophysical profile or nonstress test)
optimum management for women with preeclampsia without features of severe disease at ≥37 weeks of gestation
delivery
Why are antihypertensives not used in management of preeclampsia with BP <150/110?
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
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?
labetolol or hydralazine (IV)
