Hypertensive disorders of pregnancy

Question 1

What percent of patients with Gestational HTN will develop Pre-Eclampsia

Answer 1

50%

Question 2

Is Gestational HTN with severe range BP equivalent to preE with severe features?

Answer 2

Yes, management is the same. Mag sulfate and Delivery at 34wga

Question 3

What is the diagnostic criteria for gHTN?

Answer 3

2 BPs > 140/90 on 2 separate occasions 4 hrs apart after 20 weeks gestation

Question 4

What is the general diagnostic criteria for PreE?

Answer 4

BPs AND proteinuria OR HELLP findings

Question 5

What is the diagnostic proteinuria requirement for PreE?

Answer 5

24 hr urine protein > 300 mg OR P:C ratio > 0.3

Question 6

What are the diagnostic HELLP labs?

Answer 6

plts < 100K, LFTs 2 x upper limit of normal, Cr > 1.1 or doubling

Question 7

True or False: In order to meet criteria for severe preE by blood pressures they must be 4 hrs apart

Answer 7

FALSE, confirmed within 15 minutes to initiate therapy

Question 8

What 3 risk factors carry the highest risk of developing preE?

Answer 8

Chronic renal disease (20 fold increase), cHTN (10 fold increase), Antiphospholipid syndrome (10 fold increase)

Question 9

What is the diagnostic criteria for cHTN in pregnancy?

Answer 9

hypertension present before 20 weeks, SBP > 140, DBP > 90

Question 10

What fetal anomalies are associated with chronic HTN?

Answer 10

hypospadias, esophageal atresia, cardiac septal defects

Question 11

How do you diagnose preE in a patient with cHTN?

Answer 11

Sudden increase in BP AND/OR increase in proteinuria

Question 12

what percentage of patients with cHTN will develop SI preE?

Answer 12

30%

Question 13

What percentage of patients with cHTN AND severe end organ damage will develop SI PreE?

Answer 13

75%

Question 14

How is the Hemolysis portion of HELLP diagnosed?

Answer 14

need at least 2 criteria: Peripheral smear showing schistocytes or burr cells, serum bulirubin > 1.2mg/dL, Low serum haptoglobin, severe anemia unrelated to blood loss

Question 15

How is the Elevated LFTs portion of HELLP diagnosed?

Answer 15

LFTs 2 x the upper limit of normal or LDH > 600

Question 16

What percentage of HELLP cases occur postpartum?

Answer 16

30%

Question 17

What percentage of HELLP cases do not have HTN or proteinuria?

Answer 17

15%

Question 18

What percent of HELLP cases have RUQ pain and malaise?

Answer 18

90%

Question 19

What percent of HELLP cases have N/V?

Answer 19

50%

Question 20

When should you start anti-hypertensive therapy in a patient with chronic HTN in pregnancy?

Answer 20

If BP < 160/110 If end organ damage use > 150/100

Question 21

What is the max dose of PO labetalol that can be given in 1 day?

Answer 21

2400mg

Question 22

What is the maximum dose of Nifedipine PO that can be given in 1 day

Answer 22

120 mg XR

Question 23

When should labetalol not be used to control BP in pregnancy?

Answer 23

Patients with asthma, MI or cardiac disease

Question 24

What is the recommended dosing of Labetalol IV for acute HTN?

Answer 24

20–> 40–> 80 mg IV q 5 - 15 minutes

Question 25

What is the max dose of IV labetalol that can be given in 24 hrs

Answer 25

300 mg IV

Question 26

What is the recommended dosing of HydralazineIV for acute HTN?

Answer 26

5mg --> 10 mg --> 20 mg q 20 min

Question 27

At what gestational age should you deliver a patient with cHTN not on medication?

Answer 27

38w0d - 39w0d

Question 28

At what gestational age should you deliver a patient with cHTN on meds?

Answer 28

37w0d - 39w0d

Question 29

How do you manage outpatient preE w/o SF?

Answer 29

Weekly BP check and preE labs, NST/BPP 1-2x weekly, fetal growth q 3-4 weeks

Question 30

What is the incidence of eclamptic seizures with preE w/ SF?

Answer 30

2%

Question 31

What is the IV dosing regimen for mag sulfate?

Answer 31

4g bolus, 2g/hr through delivery and until 24 hrs post partum

Question 32

What is the IM dosing regimen for mag sulfate?

Answer 32

5mg in each buttock (10 mg total) then 5 mg q 4 hrs

Question 33

What is the therapeutic range for magnesium sulfate?

Answer 33

5-9

Question 34

At what mag level is there a loss in patellar reflexes?

Answer 34

> 9

Question 35

At what mag level is there respiratory difficulty?

Answer 35

>12

Question 36

At what mag level is there cardiac arrest?

Answer 36

> 30

Question 37

When should you typically check a mag level?

Answer 37

if there is impaired renal function, signs of toxicity or decreased UOP

Question 38

What is the elimination half life for magnesium?

Answer 38

4 hrs

Question 39

What is the antidote for magnesium toxicity?

Answer 39

1 amp of calcium gluconate (10ml of 10% solution IV over 3 min)

Question 40

cHTN is associated with what other complication of pregnancy besides PreE?

Answer 40

GDM

Question 41

if the P:C ratio is < ____ there is no need to collect a 25 hr urine protein

Answer 41

< 0.15

Question 42

Who are candidates for aspirin therapy (Need only one risk factor)?

Answer 42

h/o PreE, cHTN, Type 1 or 2 DM, multifetal gestation, renal disease, autoimmune disease

Question 43

Who are candidates for aspirin therapy (Need two risk factors)?

Answer 43

Nuliparous, AMA > 35 yrs, Obesity > 30, African American race, family history of PreE, prior SGA, > 10 years since last pregnancy, low SES

Question 44

When should you initiate aspirin therapy?

Answer 44

between 12 - 28 wks

Question 45

Starting aspirin therapy reduces incidence of preeclampsia by _____

Answer 45

24%

Question 46

Starting aspirin therapy reduces incidence of FGR by _____

Answer 46

20%

Question 47

Starting aspirin therapy reduces incidence of preterm birth by _____

Answer 47

14%