Medical Complications of Pregnancy I -Castro Flashcards
What is one theory about the etiology of preeclampsia?
uteroplacental ischemia or decreased blood flow (multiple causes)–> “toxin” release (such as lipid peroxides or oxygen free radicals —> endothelial damage and alterations in vasoactive substances –> local and systemic vasospasm –> more dec in blood flow
What is the pathophysiology of preeclampsia?
Inc vascular reactivity –> inc sensitivity to angiotensin II –> HTN and dec organ perfusion
Vascular endothelial damage –> leaky capillaries –> edema and low plasma volume (intravascular)
Extravascular volume may be increased
What is the only cure for preeclampsia?
delivery
What are some of the systemic pathologic changes seen in preeclampsia?
- Uteroplacental implantation site: inadequate invasion of spiral arteries (still have muscular layer in vessel wall) leads to decreased placental perfusion, hypoxia and atherosis (necrosis)
- Renal lesion (glomerular capillary endotheliosis): capillary loops dilated and contracted; swelling of glomerular capillary endothelial cells
- brain
- liver
What are the risk factors for preeclampsia? (6)
- Nulliparity
- Extremes of maternal age (teens and old)
- Prior hx of preeclampsia (espec preterm preeclampsia)
- Family hx of preeclampsia (mother, sister)
- Trophoblastic disease (at risk for early onset preelampsia, <20 wks)
- underlying maternal disease (HTN, DM, renal disease, vascular disease, cocaine/meth)
What is the standard diagnostic criteria for preeclampsia?
- New onset hypertension (140+/90+) and proteinuria (0.3g+ protein in 24 hour urine OR > 30 or +1 on a urine dipstick after 20 weeks gestation
- with or without edema
What is the diagnostic criteria for preeclampsia without proteinuria?
-BP or 140+/90+ after 20 weeks gestation PLUS one of the following:
- Headache or visual symptoms (CNS symptoms)
- Thrombocytopenia
- Elevated Serum Cr (greater than 1.1)
- Elevated LFT’s (transaminases)
- Pulmonary edema
What is the criteria for preeclampsia with severe features?*
-Severe hypertension (BP>/= 160/110 on two occasions 4 hrs apart)
-Cerebral (headache) or visual disturbances
-Pulmonary edema
-Serum Cr > 1.1 or doubling of Cr
-Thrombocytopenia or HELLP
-Hepatic abnormality (RUQ or epigastric pain,
Nausea & vomiting, Elevated LFT’s (transaminases)
What is HELLP?
- Hemolysis (abnormal blood smear, bilirubin > 1.2, LDH > 900)
- Elevated liver functions (AST OR ALT)
- Low platelets (<100,000)
What is the diagnostic criteria for eclampsia? When is this normally diagnosed?
Presence of new onset grand mal seizures in a woman with preeclampsia
50% intrapartum (30% can occur post partum)
What is superimposed preeclampsia? What is the criteria?
Preeclampsia superimposed on chronic hypertension
*prognosis worse than either condition alone
criteria:
-New onset proteinuria after the 20th week of gestation (>0.3 gms/24hrs) in women with chronic HTN
OR
-in women with HTN and proteinuria BEFORE 20 weeks:
-sudden increase in BP if previously well controlled
-signs, symptoms and labs consistent with severe preeclampsia
If a woman who is 18 weeks pregnant comes in with HTN and other symptoms, what is her likely diagnosis?
superimposed preeclampsia
if don’t know if she had chronic HTN before, assume she did because preeclampsia is new onset HTN after 20 weeks
What is gestational HTN of pregnancy? What can this lead to?
- Elevated BP without proteinuria occurring for the first time in the last 20 weeks of pregnancy or early postpartum in a woman who does not develop preeclampsia or chronic hypertension
- can lead to preeclampsia –> follow closely
What is the criteria for chronic HTN?
HTN diagnosed before pregnancy or before the 20th week of gestation
-HTN diagnosed first in pregnancy but persists > 12 weeks post partum
What is helpful in the prevention of preeclampsia?
lifestyle prevention BEFORE pregnancy (preconception)
