Lecture 17: HTN disorders in pregnancy Flashcards
What’s the difference between chronic vs. gestational HTN?
- Chronic HTN is present before or recognized during first half of preg.
- Gestational HTN is recognized after 20 weeks gestation
For pregnant patient w/ severe HTN (BP >160/110) what are the 3 drugs given for anti-hypertensive therapy?
- Methyldopa
- Labetalol
- Nifedipine
What is needed for the diagnosis of preeclampsia?
- HTN
- Proteinuria
- (Edema)
If pregnant pt presents with severe HTN after 38 weeks gestation what is next best step?
Delivery
What are 4 sx’s of preeclampsia?
- Scotoma (blind spot)
- Blurred vision
- Epigastric and/or RUQ pain
- Headache
What may be seen in the brain, heart, and lungs of patient with preeclampsia?
- Brain = cerebral edema and/or fibrinoid necrosis, thrombosis, microinfarcts and petechial hemorrhages
- Heart = absence of normal intravascular volume expansion (third spacing) and ↓ in circulating blood volume
- Lungs = noncardiogenic pulmonary edema
Which level of proteinuria is associated with mild vs. severe preeclampsia?
- Mild = proteinuria >300 mg/24-hr urine but <5 gms/24-hr or a single specimen urine protein:creatinine ratio of 0.3 mg/dL
- Severe = proteinuria of at least 5gms/24-hr or 3+ protein on 2 random urine dips at least 4 hours apart
What are some sx’s associated with preeclampsia which would put someone in the severe category?
- Oliguria (less than 500 mL in 24 hours) or renal insufficiency (serum Cr >1.1)
- Cerebral or visual disturbances
- Pulmonary edema
- Epigastric or RUQ pain (think subscapular hematoma)
- ↑ liver enzymes
- Thrombocytopenia
When giving magnesium sulfate to patient with preeclampsia for seizure prophylaxis what is the loading dose and maintenance dose used; what should you be monitoring?
- Loading dose is 4 gm bolus
- Maintenance dose is 2 gm/hr
- Monitor urine output and reflexes
What is the theraputic value (mg/dL) for magnesium sulfate when using prophylactically in patient with preeclampsia?
5-9 mg/dL
What is the first thing to do in patient with eclampsia; what is the first line treatment?
- First thing to do is protect the airway
- Magnesium sulfate is first-line tx
If the seizures of eclampsia are persistent after giving magnesium sulfate, what else can be given?
Lorezepam
What does HELLP syndrome stand for and is a variant of what?
- Hemolysis, Elevated Liver enzymes and Low platelets
- Variant of preeclampsia
What is the indication for delivery in patient with HELLP syndrome?
Immediate delivery
Which sx’s are common in HELLP syndrome?
- RUQ pain
- Epigastric pain
- Nausea and vomiting are common
In patient with hx of preeclampsia, especially if accompanied by an adverse outcome, multifetal gestation, chronic HTN, diabetes, renal or autoimmune disease, what is given as a preventative measure?
Baby ASPIRIN starting at 12 weeks
What is the management of preeclampsia without severe features (mild) at less than 37 weeks gestation?
- Bed rest
- Once (BPP) or twice (NST) weekly antepartum testing
- Fetal growth ultrasound every 3-4 weeks
- Office visits and lab eval.
- Possibly hospitilization
What is the management of preeclampsia without severe features (mild) at 37-40 weeks gestation?
- If favorable cervix-induction
- If unfavorable cervix - use a cervical ripening agent to begin induction
What is the management of preeclampsia with severe features; when would you deliver; what are the anti-hypertensive medication options; what if <37 weeks?
- Immediate hospitalization
- Delivery if >34 weeks
- Management of BP: hydralizine, labetalol, nifedipine
- If <37 weeks administer corticosteroids and work towards delivery as long as pt and fetus are stable
