OB exam 1 - HTN disorders Flashcards
HTN causes an increased risk of
placental abruption, preterm delivery, and intrauterine growth restriction
how to take a correct BP
-the cuff size (width) should be ~40% of the arm and 80% of the arm circumference should be covered by the cuff
-pt at rest for 5 mins prior
-pt in sitting or semi reclining position
-arm at least w/ heart
gestational HTN dx
SBP >/140 or DBP >/ 90
-occurs after 20wks
-no proteinuria
-if still elevated 6wks after delivery, pt is dx w/ chronic htn
Preeclampsia
increased BP after 20 wks gestation accompanied by proteinuria
categorized by mild or severe
risk factors for preeclampsia
-chronic HTN
-chronic renal disease
-diabetes
-rH incompatibility
-primigravidity (1st preg)
-family hx
-maternal age <20 or >40
-multiple gestation
-IVF
-new paternity
what decreased in preeclampsia that can contribute to the etiology
prostacyclin which is a vasodilator so vasoconstriction can occur and there is reduced renal perfusion which can lead to hypoxia of baby
pathophys of a normal pregnancy
-inc blood plasma volume
-vasodil
-dec systemic vascular resistance
-inc CO
-dec colloid osmotic pressure
pathophys of preeclampsia
inc BP leading to dec placental perfusion causing
1)vasco
2)activation of coagulation cascade
3)intravascular fluid redistribution
how do we prevent preeclampsia for pt’s who are at risk
start 81mg of low dose aspirin between 12-28wk
where does funneling of preeclampsia occur and what does it prevent
funneling occurs between the endometrium and myometrium and it prevents good blood flow to the uterus
preeclampsia symptoms
-epigastric pain
-CNS (headache, blurred vision)
-bleeding
-N/v
hemolytic issues in preeclampsia
-low platelets
-aqueous liver enzymes
-DIC
-renal failure
-HELLP syndrome
what do capillary leaks cause in preeclampsia
-proteinuria
-facial edema
-pulmonary edema
-ascites
-pleural effusions
fetal manifestations of preeclampsia
-chance of placental abruption
-abnormal umbilical artery doppler d/t abn blood flow
-low ammonitic fluid
-growth restriction
-stillbirth
symptoms of severe preeclampsia
-visual disturbances & headaches
-fetal growth restrictions
-irritability/hyperreflexia
-retinal edema, retinal arteriolar narrowing d/t dec perfusion
if the kidneys are not being perfused well during preeclampsia, what are the effects
-oliguria
-proteinuria
-general edema
what are labs to be checked for preeclampsia
CBC, liver enzymes (LDH, AST, ALT), chemistry panel (BUN, creatinine, glucose, uric acid), type & screen and/cross mathc
+24 hr urien collection for protein & creat clearance
mild preeclampsia dx
-SBP >/ 140 or DBP >/ 90 on 2 occasions at least 4hrs apart w/ previously normal BP
-proteinuria >300mg/24hr
-pro:creat >/ 0.3
~edema
severe preeclampsia dx
-SBP >/ 160 or DBP >/ 110 on 2 occasions at least 4 hrs apart while pt is on bedrest (unless on anti htn)
-proteinuria >/ 300mg/24hr
-platelet count <100,000
-pulmonary edema
-cerebral or vision changes
-liver enzymes > twice the upper limit
-epigastric pain
home mgt of mild preeclampsia
-education to recognize worsening preeclampsia
-encourage frequent rest, lateral position
-daily BP & wt
-daily fetal movement count
if home mgt of preeclampsia is not successful, what is hospital mgt
-bed rest
-daily wts
-daily pressure 4x a day
-diet: mod to high pro, moderate Na
-fetal movement assessments
what are the major difference in check between GHTN & preeclampsia
GHTN: check NST 1x/wk & check for protein
Pre: do not need to check protein bc we know it is present & NST 2x/wk
what does a deep tendon reflex tell us
how irritated the CNS is
important bc the most irritated means the higher chance for a seizure
what does preeclampsia mean
“before the seizure”
clonus reflex
relax the lower leg and dorsiflex the foot, if the foot taps back, those taps are called beats of clonus -> this shows an irritated central nervous system
doc each foot separately
what is the main form of anticonvulsant therapy
magnesium sulfate
care for severe preeclampsia
-complete bed rest + decreased environmental stimuli
-mag sulfate
-fluid & lytes replacement
-corticosteroids for lung maturity
-anti htn (labetalol and hydralazine)
what medications are used to treat acute severe htn
-IV labetalol
-IV hydralazine
-oral nifedipine
contraindication for labetalol
asthma
contraindication for hydralazine
tachycardia
contraindication for nifedipine
tachycardia
how to give mag sulfate
start w/ a loading dose of 4-6g IV bolus over 20 mins then maintenance of 2g/hr
how long do you continue mag sulfate postpartum
24 hours -> within this time if a seizure occurs then give another 2g bolus
IV mag sulfate can help treat what conditions
eclampsia, severe preeclampsia & HELLP
common side effects of mag sulfate
headache
N/v
hot flushes
sedation
muscle weakness
mag sulfate toxicity
-decreased or absent reflexes
-decreased respiratory rate
-change in LOC
therapeutic level is 4-7
what is the antidote to magnesium sulfate
IV calcium gluconate
eclampsia
when a patient has a grand mal seizure during pregnancy that can lead to a coma
how do we manage a seizure during pregnancy (eclampsia)
prevent recurrence
maintain airway & place pt on side -> assess fetus -> proceed w/ emergent delivery if there is evidence of fetal hypoxia or abruption
note time of onset, body involvement, duration, suction as needed
what do we give during an eclampsia seizure
mag sulfate bolus -6gm
after seizure occurs (eclampsia), what is the following assessments
-check fetal status & signs of labor
-check for signs of placental abruption (vaginal bleeding, uterine rigidity)
-consider induction of labor if delivery is delayed
intrapartal mgt
-possible induction w/ oxytocin or c section
-signs of worsening preeclampsia assessed
-electronic fetal monitoring
-pain relief
postpartum mgt
-monitor vaginal bleeding, signs of shock
-assess BP and pulse
-continue to monitor fo seizures during the first week PP
-continue mag sulfate for 24 hours after delivery
HELLP syndrome
hemolysis, elevated liver enzymes, and low platelet count associated w/ severe preeclampsia which causes liver distention, epigastric pain and possible liver rupture
possibly ends in DIC
HELLP sx
N/v
flu like symptoms
epigastric pain
HELLP tx
attempt to stabilize
delivery of fetus regardless of gestation 34 wks benefit from being on steroids for 48 hours for lung maturity
chronic HTN
SBP >/ 140 or DBP >/90 either before pregnancy, before 20 wk GA, or remains 6wks PP
goals of chronic HTN
-watch for development of superimposed preeclampsia
-evaluate growth of fetus every 4wk by ultrasound
chronic htn tx
home mgt as much as possible
-bed rest
-lateral side lying
-diet (balanced, ade/high pro. ade Na)
-meds
-24hr urine study for baseline
-labs (as as preC)
-regular NST & BPP
chronic HTN w/ superimposed preeclampsia
sudden increase in previously well controlled BP or if more anti htn meds are needed
chronic HTN w/ superimposed preeclampsia sx
new proteinuria (or escalation)
upper body edema
rise in serum uric acid
chronic HTN w/ superimposed preeclampsia tx
originally treated for chronic but now treated as if they have preeclampsia
