lecture 8: hypertensive disorders in pregnancy, wootton

Question 1

definition of HTN in pregnancy

Answer 1

sustained BP higher than 140/90

Question 2

classification of HTN

chronic
gestastional
preeclampsia
eclampsia
superimposed preelampsia/eclampsia

Answer 2

chronic- present before or recognized during 1st half of preg

gestational- recgonized after 20 weeks gestation

preeclampsia occurs after 20 weeks gestation with proteinuria

eclampsia is new onset seizure with preeclampsia

superimposed is transposed onto chronic HTN

Question 3

maternal risks HTN

Answer 3

heart problem
cerebral vascular
renal
hepatic failure

Question 4

fetal complications HTN

Answer 4

fetal growth restriction
preterm
placental abruption
stillbirth neonatal death

Question 5

chronic HTN eval

Answer 5

assess for maternal end organ damage
-CBC,glucose, CMP, 24 hour urine, EKG

assess fetal well being with US

Question 6

mild HTN treatment (less than 160/110)

Answer 6

antiHTN therapy
prenatal visits every 2-4 weeks until week 34-36, then weekly
deliver btwn 39-40 weeks

Question 7

symptoms with preelcmapsia

Answer 7

blurred vision
RUQ pain or epigastric
HA

Question 8

risk factors for preeclampsia

Answer 8

under 20 or over 35 yrs old***
multiple gestation
diabetes
thyroid disease, renal disease, vascular disesae
chronic HTN

Question 9

preelampsia what happens to organs

Answer 9

brain edema, hemorrhages, infarct

heart (third spacing) reduced blood volume

lungs- noncardiogenic pulmonary edema

liver- hemorrhage and rupture, RUQ pain

kidney- swell and enlarged glom caps

eyes- retinal vasopasm and edema

Question 10

preeclampsia without severe features (mild)

Answer 10

BP over 140/90 but under 160/110
proteinuria over 300 mg but less than 5 gms in 24 hrs
-asymptomatic

Question 11

preeclampsia with severe features

Answer 11

BP over 160/110
proteinuria of at least 5 grams in 24 hrs or 3+ protein on two random urine dips at least 4 hours apart***

oliguria and symptomatic

Question 12

lab values preeclampsia

hematocrit, LDH, AST and ALT, uric acid, platelts

Answer 12

all increased but platelets are decreased

Question 13

managment with mild preeclamp

• less than 37 weeks
• btwn 37-40 weeks

Answer 13

less than 37–> bed rest, US every 3-4 weeks

btwn 37-40–> if favorable then cervix induction, if not ripen cervix

Question 14

manage severe preelampsia

Answer 14

immediate hospitalization
deliver if greater than 34 weeks
hydralizine, labetalol, nifedipine

use corticosteroids if less than 37 weeks

Question 15

what delivery preferred with HTN

Answer 15

vaginal

Question 16

mg sulfate loading dose, maintenance dose, and therapeutic value for preeclampsia

Answer 16

load: 4 gm bolus
maint: 2 gm/hr
therap value: 4.8-9.6 mg/dL

Question 17

eclampsia first thing to do

Answer 17

protect airway then mg sulfate, zepam if persistent

Question 18

symptoms of HELLP

Answer 18

RUQ, epigastric pain, nausea, vomit

Question 19

what may help prevent preeclampsia

Answer 19

aspirin

Question 20

39 yr old at 38 weeks gestation, no complaints but BP is 158/90 and urine dip is +1 what do you do

Answer 20

24 hr urine, cbc, cmp, put kid on moniter, US

Question 21

clinical exam findings preeclampsia

Answer 21

brisk reflex
clonus
edema