OB final exam- S4 Flashcards
What is the condition?
Patient has diagnosis of essential HTN before pregnancy
- Systolic of 140 or greater
- Diastolic of 90 or greater
- Before pregnancy or before 20 weeks gestation
- Risk of superimposed preeclampsia
Chronic Hypertension
What is the condition?
- Most frequent cause of HTN during pregnancy often after 37 weeks
- Elevated BP after 20 weeks gestation WITHOUT proteinuria
- Usually resolves by 12 week postpartum
- May lead to chronic HTN
Gestational Hypertension
What is the condition?
- Multi-organ disease with NEW onset of HTN and Proteinuria after 20th week gestation.
Preeclampsia
What is the condition?
- Preeclampsia in 20-34 weeks
- Younger than 18 or older than 45 yo
- Fetal growth restriction
- Familial component
- Primarily placental
- 20% of cases
Early Form (Type I) Preeclampsia
What is the condition?
- Preeclampsia after 34 weeks
- From obesity, DM or high cholesterol
- No fetal growth restriction
- No familial component
- 80% of cases
Late Form (Type II) Preeclampsia
What is the condition?
- BP ≥ 140/90 after 20 weeks gestation
- Proteinuria
- Asymptomatic, mild headaches that resolve
Preeclampsia WITHOUT Severe Features
(Mild preeclampsia)
What is the condition?
- BP ≥ 160/110
- Thrombocytopenia (platelets < 100,000)
- Creatinine > 1.1
- Oliguria < 500ml in 24hr
- Pulmonary edema
- Severe RUQ or Epigastric pain
- Visual disturbances
Preeclampsia WITH Severe Features
What is the condition?
- New onset of seizures or unexpected Coma in preeclamptics without disorder
- Headache and visual disturbances
- Central nervous system involvement
- up to 6 weeks postpartum
- Associated with placental abruption
- Must deliver baby
Eclampsia
What is the condition?
- Hemolysis, Elevated Liver enzymes, Low Platelet with preeclampsia
- Elevated bilirubin
- AST > 70
- ALT elevated
- Platelets <100k
- Lactate > 600
- BP can be normal
- Associated with DIC, placental abruption, liver hemorrhage, renal failure, ARDS
- Clear indication is if patient is trending down in labs and >30k drop in platelets q6h
HELLP syndrome
What is the condition?
- Presence of new onset proteinuria or sudden increase in proteinuria
- HTN already
- Very hard to differentiate with preeclampsia
Chronic HTN with superimposed Preeclampsia
What is the condition?
- Preeclampsia with or without severe organ involvement
- Seizures can develop in the postpartum period
- Presents within 7 days of delivery
- Can develop from 2-6 weeks postpartum
Post partum Hypertension
What is a protective factor from developing Preeclampsia?
Smoker
The nicotine inhibition of thromboxane A-2 synthesis and stimulates nitric oxide release
First pregnancy
Advanced maternal Age
Previous history
Family history
Chronic HTN
Chronic Renal disease
DM
Multiple gestation
Obesity
Black
Risk factors of developing Preeclampsia
Fetal Growth Restriction, Oligohydramnios and Abnormal oxygen exchange are associated with what?
Fetal Syndrome associated to Preeclampsa
New onset Hypertension and Proteinuria after 20 weeks gestation are associated with what maternal condition?
Preeclampsia
Defective trophoblastic invasion can lead to what 3 things?
- Reduced uteroplacental blood flow
- Stressed placenta
- Preeclampsia
What is the ultimate resolution of preeclampsia?
Delivery of the placenta.
T/F
Preeclampsia can occur without a fetus?
True
It is the placenta that causes preeclampsia
How are the spiral arteries affected during preeclampsia?
They cannot undergo vessel remodeling and lead to decreased blood flow causing multi organ disease
In preeclampsia there is hyperperfusion of the brain, what are some common symptoms associated with that?
Severe unrelieved headache
Coma
Visual disturbances
Hemorrhagic stroke
Loss of cerebral vascular autoregulation
What biomarker can identify cardiac dysfunction in preeclamptic mothers?
BNP
What is the most common hematologic disorder in women with preeclampsia?
Thrombocytopenia
What is the most common cause of severe thrombocytopenia in the second half of pregnancy?
Preeclampsia
Low fibrinogen
Prolonged PT and PTT
Drop in platelets
Signs of bleeding
Severe liver involvement
Fetal Demise
Are all signs/symptoms of what severe issue?
DIC