Midterm- preeclampsia

Question 1

chronic hypertension

Answer 1

walk into pregnancy with HTN

Question 2

chronic hypertension with superimposed preeclampsia

Answer 2

someone who walks into PG with HTN and later in PG developed preeeclampsia

Question 3

gestational hypertension

Answer 3

develops HTN in PG, but not preeclampsia

Question 4

preeclampsia/eclampsia

Answer 4

systemic vasculitis

HTN + proteinuria

Question 5

diagnostic criteria for mild preeclampsia

Answer 5

bp: 140/90 or greater in a woman previously normotensive
protein: 300 mg or greater on 24 hr urine collection

Question 6

eclampsia

Answer 6

occurrence of generalized convulsions or coma associated with preeclampsia without other neurological conditions

Question 7

for proteinuria what number is diagnostic?

what test? why not spot urine test?

Answer 7

• 300 mg or greater
• 24 hour urine collection
• because urine could be concentrated if patient is dehydrated

Question 8

sx for preeclampsia?

Answer 8

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)

Question 9

risk factors - med conditions

Answer 9

diabetes
chronic HTN
vascular or connective tissue diseases
obesity
chronic renal disease

Question 10

risk factors- PG associated factors

Answer 10

chormosomal AbN
hydatidiform mole
erythroblastosis fetalis (ABO RH incompatibility and baby has hemolytic anemia)
multiple PG
oocyte donation or donor insemination
thrombophilias

Question 11

risk factors- maternal specific factors

Answer 11

age less than 20 or greater than 35 yo
nulliparity
previous personal history of preeclampsia
FHx of preeclampsia
stress

Question 12

risk factors- paternal specific factors

Answer 12

first time father
previously fathered a preeclamptic PG in another woman
limited sperm exposure with current father of baby

Question 13

theories of etiology of preeclampsia

Answer 13

abnormal trophoblastic invasion
vascular endothelial damage
genetic predisposition
coagulation AbN
cardiovascular maladaptation
immunologic phenomena
dietary deficiencies or excess

Question 14

normal immunologic phenomena in PG

Answer 14

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

Question 15

immunologic phenomena thought to occur in preeclampsia

Answer 15

• 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

Question 16

in normal pregnancy, there is a balance btwn angiogenic factors and antagonizing factors. Give some examples of both

Answer 16

angiogenic factors:
placental growth factors
vascular endothelial growth

antagonizing factors:
endoglin
soluble fms-like tyrosine kinase

Question 17

fetalplacental ischemia may lead to an imbalance between angiogenic and antagonizing factors- in which direction?

Answer 17

incr antagonizing factors (antiangiogenic factors enter maternal circulation leading to systemic sx of preeclampsia)
decr angiongenic factors

Question 18

Nutritional deficiencies/excesses

Answer 18

deficient protein
excess protein
inadequate fresh fruit/vegetables for antioxidants
calcium, magnesium deficiencies

Question 19

PN visits

Answer 19

• 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

Question 20

baseline lab workup for women at risk preeclampsia

Answer 20

hemoglobin/hematocrit
platelet count
12 or 24 hr protein collection
serum creatinine level
serum uric acid level

Question 21

lab workup in women who develop HTN after 20 weeks

Answer 21

CBC, CMP, 24 hr urine collection plus

• AST/ALT
• Serum albumin
• LDH
• Coagulation profilef

Question 22

renal test
normal PG
in preeclampsia

Answer 22

normal:
GFR incr, creatinine, urea and uric acid levels decr
preeclampsia
GFR decr, creatinine normal, uric acid incr

Question 23

hepatic function

Answer 23

abnormal tests only found in 10% of women with severe preeclampsia (if see AbN liver function need to rule out HELLP syndrome)

Question 24

hematologic

Answer 24

thrombocytopenia is the best indicator of severity of disease
increasing Hgb/Hct (due to hemo concentration because you are loosing fluid due to edema)

Question 25

assessment of fetal well being

Answer 25

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

Question 26

treatment for labor in sever preeclampsia

Answer 26

magnesium sulfate - can reduce eclamptic seizures in labor

Question 27

maternal complications of preeclampsia?

Answer 27

end organ damage!
renal 
hepatic
cerebrovascular
opthalmic
cardiovascular and pulmonary
hematologic
HELLP syndrome

Question 28

fetal complications of preeclampsia

Answer 28

IUGR
prematurity
intra-uterine fetal death

Question 29

dietary patterns for preeclampsia

Answer 29

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

Question 30

supplements

Answer 30

• 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

Question 31

drugs

Answer 31

-aspirin shown to have small to moderate benefits in prevention of preeclampsia

Question 32

air polution

Answer 32

incr risk of preeclampsia and preterm brith