Medical Complications

Question 1

How many deaths occur d/t HTN?

Answer 1

20% of maternal deaths

Question 2

Define chronic HTN

Answer 2

HTN before 20th wk or before Pg

Question 3

Define Pg induced HTN (PIH)

Answer 3

after 20wks in the absence of proteinuria, that returns to nml postpartum 25% will develop preeclampsia or ecclampsia

Question 4

Define mild preeclampsia

Answer 4

HTN after 20wks plus proteinuria 0.3g/d or >1+ on dipstick (BP readings 6hrs apart in 1 wk), can have edema

Question 5

Define severe preeclampsia

Answer 5

SBP > 160, DBP > 110, > 5g proteinuria/3+ on dipstick, oliguria < 500ml, HA, scotomata, pulm edema, cyanosis, RUQ pain, hepatic dysfxn, thrombocytopenia, IUGR

Question 6

Define ecclampsia

Answer 6

grand mal seizure w/preeclampsia, most cases occur w/in 24hrs

Question 7

What is the workup for HTN?

Answer 7

CBC, liver panel, coags, 24hr urine, CrCl, urine protein. Fetus: US, Biophysical profile/non stress test (mov’t, fluid vol, HR, tone, breathing)

Question 8

What is the tx for chronic HTN?

Answer 8

meds only if SBP > 150 or DBP > 100. Labetolol, methyldopa, nifedipine

Question 9

What is tx for preeclampsia?

Answer 9

rest, biophysical profile 2x’s/wk, US q 3 wks, daily kick cts (10+ per hr after eating), hospitalization, induction after 37wks, prophylactic tx MgSO4 for severe preeclampsia

Question 10

What is tx for eclampsia?

Answer 10

hospitalization, daily labs/fetal monitoring, labetolol or hydralazine to reduce DBP < 100mmHg, MgSO4 for seizure prevention/abortion, induction after 34wks

Question 11

What is HELLP syndrome?

Answer 11

Hemolytic anemia, Elevated liver enzymes, Low Platelets, in 3rd trimester

Question 12

What are sx’s of HELLP syndrome?

Answer 12

malaise, HA, N/V, epigastric pain, RUQ pain

Question 13

What is tx for HELLP?

Answer 13

hospitalize, deliver, fresh frozen plasma transfusion, MgSO4, antihypertensives

Question 14

What is PROM?

Answer 14

premature rupture of membranes: term is 37wks, preterm PPROM < 37wks (leading cause of neonatal morbidity/mortality)

Question 15

How do you Dx PROM?

Answer 15

Ntirazine pH test (amniotic fluid is alkaline–turns blue), ferning on microscope slide, use STERILE speculum, no digital exams!

Question 16

How do you tx term PROM?

Answer 16

wait to deliver up to 24hrs unless infxn, treat GBS, induce labor

Question 17

Tx for PPROM?

Answer 17

steroids (no steroids > 34wks), wait for labor, induce/deliver if infxn, tx GBS

Question 18

What is prolonged ROM?

Answer 18

ROM > 24hrs