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Obstetrics > Hypertensive disorders of pregnancy > Flashcards

Hypertensive disorders of pregnancy Flashcards

1
Q

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

A

50%

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2
Q

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

A

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

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3
Q

What is the diagnostic criteria for gHTN?

A

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

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4
Q

What is the general diagnostic criteria for PreE?

A

BPs AND proteinuria OR HELLP findings

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5
Q

What is the diagnostic proteinuria requirement for PreE?

A

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

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6
Q

What are the diagnostic HELLP labs?

A

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

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7
Q

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

A

FALSE, confirmed within 15 minutes to initiate therapy

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8
Q

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

A

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

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9
Q

What is the diagnostic criteria for cHTN in pregnancy?

A

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

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10
Q

What fetal anomalies are associated with chronic HTN?

A

hypospadias, esophageal atresia, cardiac septal defects

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11
Q

How do you diagnose preE in a patient with cHTN?

A

Sudden increase in BP AND/OR increase in proteinuria

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12
Q

what percentage of patients with cHTN will develop SI preE?

A

30%

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13
Q

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

A

75%

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14
Q

How is the Hemolysis portion of HELLP diagnosed?

A

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

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15
Q

How is the Elevated LFTs portion of HELLP diagnosed?

A

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

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16
Q

What percentage of HELLP cases occur postpartum?

A

30%

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17
Q

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

A

15%

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18
Q

What percent of HELLP cases have RUQ pain and malaise?

A

90%

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19
Q

What percent of HELLP cases have N/V?

A

50%

20
Q

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

A

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

21
Q

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

A

2400mg

22
Q

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

A

120 mg XR

23
Q

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

A

Patients with asthma, MI or cardiac disease

24
Q

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

A

20–> 40–> 80 mg IV q 5 - 15 minutes

25
Q

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

A

300 mg IV

26
Q

What is the recommended dosing of HydralazineIV for acute HTN?

A

5mg –> 10 mg –> 20 mg q 20 min

27
Q

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

A

38w0d - 39w0d

28
Q

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

A

37w0d - 39w0d

29
Q

How do you manage outpatient preE w/o SF?

A

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

30
Q

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

A

2%

31
Q

What is the IV dosing regimen for mag sulfate?

A

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

32
Q

What is the IM dosing regimen for mag sulfate?

A

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

33
Q

What is the therapeutic range for magnesium sulfate?

A

5-9

34
Q

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

A

> 9

35
Q

At what mag level is there respiratory difficulty?

A

> 12

36
Q

At what mag level is there cardiac arrest?

A

> 30

37
Q

When should you typically check a mag level?

A

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

38
Q

What is the elimination half life for magnesium?

A

4 hrs

39
Q

What is the antidote for magnesium toxicity?

A

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

40
Q

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

A

GDM

41
Q

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

A

< 0.15

42
Q

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

A

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

43
Q

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

A

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

44
Q

When should you initiate aspirin therapy?

A

between 12 - 28 wks

45
Q

Starting aspirin therapy reduces incidence of preeclampsia by _____

A

24%

46
Q

Starting aspirin therapy reduces incidence of FGR by _____

A

20%

47
Q

Starting aspirin therapy reduces incidence of preterm birth by _____

A

14%

Obstetrics (28 decks)

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