OB: LATE PREGNANCY HTN AND PRE-E Flashcards
is hypertension that predates the pregnancy. This is defined as blood pressure of ≥ 140/≥ 90 before 20 weeks’ gestational age.
Chronic hypertension (cHTN)
Women who are pregnant or trying to conceive should avoid these antihypertensive medications
must avoid ACE/ARBs entirely
What hypertensive meds are safe in pregnancy?
Safety has been established for labetalol, hydralazine, and dihydropyridine calcium-channel blockers, such as nicardipine
Labetalol, hydralazine, and nifedipine are used to treat cHTN and are the medications of choice for treating eclampsia when BP exceeds 160/110. ACOG recommends AGAINST treating blood pressure until it reaches the range of preeclampsia with severe features. If BP is > 160/110, treat immediately. If not, do not treat the blood pressure, even if the patient has known cHTN.
When do we treat BP in pregnancy?
ACOG recommends AGAINST treating blood pressure until it reaches the range of preeclampsia with severe features. If BP is > 160/110, treat immediately. I
Gestational htn
Gestational hypertension (gHTN) is elevated BP without any signs of preeclampsia.
For elevated blood pressure to be considered part of the eclampsia disease spectrum, there must be a sustained elevation in blood pressure (for obstetrics: 140/90) with onset after 20 weeks’ gestation. During pregnancy, blood pressure should decrease until 26 weeks, then gradually return to normalfor the remainder of the pregnancy.
If your pt has gHTN, what should u order to rule out pre-e?
If gHTN . . . measure urine protein to rule out preeclampsia.
What urine protein do we see in pre-e?
The eclampsia spectrum leads to leaky capillaries. Leaky glomerular capillaries lead to the filtration of albumin and other proteins. If there is proteinuria > 300 mg/dL,the gestational hypertension has increased in severity to preeclampsia.
How do we treat htn in moms with Pre-e?
Treating elevated blood pressure shows no benefit in women diagnosed with eclampsia spectrum disorder (as opposed to chronic hypertension). Because the blood pressures—systolic and diastolic—are criteria for escalating the diagnosis to preeclampsia with severe features, a patient who is diagnosed with preeclampsia without severe features does not need her blood pressure controlled.
Criteria for pre-e with severe features
How do we manage pre e with severe features?
Anti-hypertensive therapy to control blood pressure is often needed, anticonvulsant therapy (magnesium) should be ready to be infused, and induction of labor is warranted. If past 37 weeks’ gestation, simply deliver. If the infant is preterm—less than 34 weeks’ gestation—fetal lung maturity must be assessed, and the benefits of further gestation must be weighed against maternal risk. Wait until week 34 to deliver. Reasons not to wait until week 34 are included to the right. Between 34 and 37 weeks’ gestation is more controversial. The data point toward improved maternal outcomes but slightly worse outcomes for baby. Because delivery is the only cure for eclampsia spectrum diseases, we want you to learn, “if 34–37 weeks’ gestation, deliver” (which means between 340/7 and 366/7)
Magnesium sulfateis provided prophylactically during labor and for 24 hours after. Magnesium sulfate is used to prevent and treat seizures associated with the eclampsia spectrum. Blood pressure is treated with labetalol, hydralazine, or nifedipine. If the blood pressure is below 160/110, there is no benefit in treating it; if above, actively treat to reduce the blood pressure to below 160/110.
What does HELLP stand for in HELLP syndrome?
hemolysis, elevated liver enzymes, and low platelets
What are the major distinguishing features among pre-e, ecclampsia, and HELLP?
Whereas eclampsia is diagnosed by the presence of a seizure (leaky capillaries in the brain) and preeclampsia is diagnosed by the presence of protein in the urine (proteinuria), HELLP syndrome is diagnosed by the presence of hepatic disease.
How is HELLP treated?
Eclampsia and HELLP syndrome are treated the same way—magnesium and delivery
Why must we do mag checks when infusing magnesium?
Magnesium sulfate infusion requires mag checks.Routine assessment of serum magnesium levels is discouraged. Instead, frequently assess the patellar deep tendon reflexes. A reduced patellar reflexis one of the earliest signs of magnesium toxicity. Eventually, magnesium will paralyze all muscle, even cardiac muscle. The patellar reflex is the first to fall victim to toxic magnesium levels. Loss of motor function is usually ascending, and the patellar reflex is easy to find, easy to elicit, and will keep getting worse, reaching full paralysis before the diaphragm is paralyzed. Failing to reduce the magnesium infusion will result in respiratory paralysis and, eventually, cardiac death. Intravenous calcium(in whatever form) is the antidote.
How do we treat magnesium toxicity?
calcium
