Hypertensive Disorders of Pregnancy

Question 1

Diagnostic Criteria for HELLP Syndrome

Answer 1

Lactate dehydrogenase > 600 IU/L
and
AST and ALT > 2 x ULN
and
Platelets < 100,000 x 10^9/L

Question 2

High Risk Factors for Preeclampsia

low-dose aspirin recommended for one or more

Answer 2

History of preeclampsia
Multifetal gestation
Chronic HTN
Type 1 or 2 DM
Renal disease
Autoimmune disease (SLE, antiphospholipid syndrome)

Question 3

Moderate Risk Factors for Preeclampsia

low-dose aspirin recommended for >1

Answer 3

Nulliparity
BMI >30
Family history of preeclampsia(mother/sister)
African American
Low socioeconomic status
AMA
Previous adverse pregnancy outcome 
>10 year pregnancy interval
Previous SGA

Question 4

Treatment of Magnesium Toxicity

Answer 4

Calcium gluconate 10% solution 10 mL IV over 3 minutes

Furosemide IV to accelerate urinary excretion

Question 5

Emergent Therapy for Sustained Severe Range Blood Pressures: Labetalol

Dose escalation
Max cumulative IV dose
Contraindications

Answer 5

Dosing: 20 mg IV > 10 minutes > 40 mg IV > 10 minutes > 80 mg IV > move onto hydralazine

Max cumulative IV dosage: 300 mg (max daily oral dose 2,400 mg)

Contraindications: Asthma, preexisting myocardial disease, decompensated cardiac function, heart block and bradycardia

Question 6

Emergent Therapy for Sustained Severe Range Blood Pressures: Hydralazine

Dose escalation
Max cumulative IV dose
Side effects

Answer 6

Dosing: 5-10 mg IV or IM > 20 minutes > 10 mg IV > 20 minutes > move to a different agent

Max cumulative dosage: 20 mg

Side effects: Headaches, abnormal FHT

Question 7

Emergent Therapy for Sustained Severe Range Blood Pressures: Nifedipine IR*

Dose escalation
Max cumulative dose
Side effects

Answer 7

Dosing: 10 mg PO > 20 minutes > 20 mg PO > 20 minutes > 20 mg PO > 20 minutes > move onto labetalol

Max daily dose: 180 mg

Side effects: reflex tachycardia, headaches