Midterm- preeclampsia Flashcards
chronic hypertension
walk into pregnancy with HTN
chronic hypertension with superimposed preeclampsia
someone who walks into PG with HTN and later in PG developed preeeclampsia
gestational hypertension
develops HTN in PG, but not preeclampsia
preeclampsia/eclampsia
systemic vasculitis
HTN + proteinuria
diagnostic criteria for mild preeclampsia
bp: 140/90 or greater in a woman previously normotensive
protein: 300 mg or greater on 24 hr urine collection
eclampsia
occurrence of generalized convulsions or coma associated with preeclampsia without other neurological conditions
for proteinuria what number is diagnostic?
what test? why not spot urine test?
- 300 mg or greater
- 24 hour urine collection
- because urine could be concentrated if patient is dehydrated
sx for preeclampsia?
h/a edema RUQ pain dec urinary output n/v malaise altered mentation asx (mostly women are asx- hard to catch bc sx are so similar to pregnancy)
risk factors - med conditions
diabetes chronic HTN vascular or connective tissue diseases obesity chronic renal disease
risk factors- PG associated factors
chormosomal AbN hydatidiform mole erythroblastosis fetalis (ABO RH incompatibility and baby has hemolytic anemia) multiple PG oocyte donation or donor insemination thrombophilias
risk factors- maternal specific factors
age less than 20 or greater than 35 yo nulliparity previous personal history of preeclampsia FHx of preeclampsia stress
risk factors- paternal specific factors
first time father
previously fathered a preeclamptic PG in another woman
limited sperm exposure with current father of baby
theories of etiology of preeclampsia
abnormal trophoblastic invasion vascular endothelial damage genetic predisposition coagulation AbN cardiovascular maladaptation immunologic phenomena dietary deficiencies or excess
normal immunologic phenomena in PG
trophoblasts are developing the fetus but also go to blood vessels in uterus (spiral arteries) and increase the size to get more blood.
As the cells are passing in the presence of progesterone, leukocytes tell NK cells not to kill them
immunologic phenomena thought to occur in preeclampsia
- an abnormal maternal immunological response to the trophoblasts preventing normal trophoblastic invasion
- -> maternal immune system isn’t turned down appropriately - so that the trophoblasts can’t modulate maternal spiral arteries which leads to decreased flow and as a result increased bp (HTN)
- -> fetalplacental ischemia
in normal pregnancy, there is a balance btwn angiogenic factors and antagonizing factors. Give some examples of both
angiogenic factors:
placental growth factors
vascular endothelial growth
antagonizing factors:
endoglin
soluble fms-like tyrosine kinase
fetalplacental ischemia may lead to an imbalance between angiogenic and antagonizing factors- in which direction?
incr antagonizing factors (antiangiogenic factors enter maternal circulation leading to systemic sx of preeclampsia)
decr angiongenic factors
Nutritional deficiencies/excesses
deficient protein
excess protein
inadequate fresh fruit/vegetables for antioxidants
calcium, magnesium deficiencies
PN visits
- ask about preeclampsia sx at each visit (h/a, visual changes, edema, RUQ or epigastric pain, digestion, appetite, energy)
- measure BP, fundal height, weight gain, assess edema
- reflexes
baseline lab workup for women at risk preeclampsia
hemoglobin/hematocrit platelet count 12 or 24 hr protein collection serum creatinine level serum uric acid level
lab workup in women who develop HTN after 20 weeks
CBC, CMP, 24 hr urine collection plus
- AST/ALT
- Serum albumin
- LDH
- Coagulation profilef
renal test
normal PG
in preeclampsia
normal:
GFR incr, creatinine, urea and uric acid levels decr
preeclampsia
GFR decr, creatinine normal, uric acid incr
hepatic function
abnormal tests only found in 10% of women with severe preeclampsia (if see AbN liver function need to rule out HELLP syndrome)
hematologic
thrombocytopenia is the best indicator of severity of disease
increasing Hgb/Hct (due to hemo concentration because you are loosing fluid due to edema)
assessment of fetal well being
consider US at 25-28 weeks for high risk women
after dx: daily fetal movement counts, non-stress tests and or biophysical profile 1-2X per week, doppler flow velocimetry
treatment for labor in sever preeclampsia
magnesium sulfate - can reduce eclamptic seizures in labor
maternal complications of preeclampsia?
end organ damage! renal hepatic cerebrovascular opthalmic cardiovascular and pulmonary hematologic HELLP syndrome
fetal complications of preeclampsia
IUGR
prematurity
intra-uterine fetal death
dietary patterns for preeclampsia
high intake vegetables, plant foods, and vegetable oils = decr risk of preeclampsia
high intake of processed meat, sweet drinks and salty snacks = incr risk of preeclampsia
supplements
- calcium shown to reduce HTN and preeclampsia
- folic acid shown to reduce risk of preeclampsia
- vit C and E not shown to reduce risk
- vit D shown to have protective effect on both mother and infant (if given post natally) in developing preeclampsia
- progesterone needs more research, but preliminary study showed it blunted HTN in rats
- L-Arginine incr NO which causes vasodilation and may prevent preeclampsia
drugs
-aspirin shown to have small to moderate benefits in prevention of preeclampsia
air polution
incr risk of preeclampsia and preterm brith
