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OBAb: Hypertensive Disorder Flashcards

1
Q

How do you diagnose gestational HPN?

A
  1. BP >= 140/90 after 20 weeks AOG in a previous normotensive
  2. No evidence of pre-eclampsia
  3. Hypertension resolves 12 weeks post partum
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2
Q

Criteria for preeclampsia

A
  1. BP >= 140/90 after 20 weeks AOG in a previous normotensive
  2. Proteinuria >= 300mg/24hr OR PCR >=3.0 OR +1 dipstick
  3. Thrombocytopenia < 100,000/uL
  4. Renal insufficiency Crea >1.1 or 2x baseline
  5. AST ALT 3x
  6. Cerebral symptoms
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3
Q

Criteria for preeclampsia superimposed on chronic hpn

A
  1. Chronic HPN +
  2. NEW ONSET PROTEINURIA ( no proteinuria <20 weeks AOG) plus

Sudden increase in proteinuria OR
Sudden increase in BP if with proteinuria <20 weeks AOG

plus

Thrombocytopenia

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4
Q

Criteria for pre-eclampsia with severe features

A
  1. BP >= 160/>=110
  2. (+) thrombocytopenia
  3. (+/-) proteinuria
  4. (+) Oliguria
  5. Elevated serum creatinine
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5
Q

How do you give Magnesium Sulfate for seizure protection?

A
  1. Loading dose: 4g SIVP, 5g IM at each buttocks (Total 14mg)
  2. Maintenance dose: 5g IM on alternating buttocks q6h x 4 doses (total of 20mg in 24hours)

Antidote: Calcium gluconate 1g SIVP

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6
Q

____ meqs/L where patient given MgSO4 presents with respiratory depression

A

10-12 meqs/L

At 12meqs/L, respiratory arrest can happen
>12meqs/L, altered consciousness

Antidote: Calcium gluconate 1g SIVP

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7
Q

___ meqs/L is the therapeutic dose for MgSO4 as seizure protection

A

4-7 meqs/L

Antidote: Calcium gluconate 1g SIVP

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8
Q

Cite the Tennessee Criteria for HELLP syndrome

A
  1. LDH >600 IU/L
  2. AST/ALT 2x elevated
  3. PC <100,000/uL
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9
Q

Cite the Mississippi Criteria for HELLP syndrome

A

All: LDH >=600
I PC <50 | AST/ALT >= 70
II PC 50-100 | AST/ALT >= 70
III PC 100-150 | AST/ALT >= 40

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10
Q

What is the BP Goal in Eclapmsia?

A

140/90 - 155/105

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11
Q

What is the most accepted risk factor of gestational hypertension?

A

hypertensive disorder

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12
Q

___ refers to immunologic habituation to paternal antigens through contact between the sperm and female GIT

A

immunologic habituation

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13
Q

___ refers to hypertension without proteinuria after 20 weeks gestation; BP returns to normal 12 weeks post partum

A

Gestatonal hypertenstion

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14
Q

If the BP known patient with GH became normal at 13 weeks postpartum, she can be labeled as?

A

Transient HPN

After 12 weeks, you can confirm if its transient or chronic HPN

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15
Q

Oliguria is a severe feature of pre-eclampsia. What is the expected UO of these patients?

A

<400 to 500mL/day

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16
Q

What are the renal changes in patients with pre-eclampsia?

A
  1. Decreased GFR
  2. Glomerular endotheliosis blocking filtration barrier
  3. increased endothelial leak causing elevated urine Na
  4. Increased excretion of urinary podocyte
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17
Q

What are the contraindications to conservative management of pre-eclampsia?

A
  1. Persistent symptoms of hypertension
  2. Fetal compromise
  3. Signs beginning HELLP
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18
Q

What is the dose of calcium to prevent pre-eclampsia syndrome?

A

High dose Calcium

1.5 to 2 grams per day before 32 weeks

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19
Q

When will you start aspirin for patients with pre-eclampsia to prevent pre-eclampsia syndrome?

A

Low dose aspiring

60 to 80 mg/day to start on the 2nd trimester

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20
Q

[Gestational HPN]

What are you indications for hospitalization and delivery for GH patients?

A

A. AOG >40 weeks
OR

B. AOG >/ 37 weeks if:

  1. Bishop >5
  2. Fetal weight <10th percentile
  3. Non reactive NST

C. AOG >34 weeks with

  1. Labor
  2. Ruptured membranes
  3. Vaginal bleeding
  4. Abnormal BPS
  5. Criteria for severe preeclampsia
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21
Q

What is the sonological monitoring schedule of patients with severe pre-eclampsia?

A
  1. Assess fetal size every 2 weeks
  2. BPS and AFI twice weekly
  3. Umbilical artery doppler once a week
  4. NST daily
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22
Q

What are examples of your severe features associated with preeclampsia?

A
  1. RUQ or epigastric pain
  2. Platelet <100,000/mL
  3. Transaminase 2x above nromal
  4. Serum crea >1.1 or 1.2mg/dL in the absence of renal disease
  5. Oliguria <400-500mg/day
  6. Pulmonary edema
  7. Severe headache, altered mental statu
  8. partial or total loss of vision in normal appearing eye
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23
Q

When will you deliver for patients with severe preeclapmsia?

A

32 to 34 weeks

24
Q

Patient with severe pre-eclampsia at 33-34 weeks, what will be your next step?

A
  1. give steroids

2. deliver after 48 hours

25
Patient with severe pre-eclampsia at 31 weeks weeks, what will be your next step?
1. Give steroids 2. Daily evaluation 3. Delivery if with indications 4. Deliver at 32 to 34 weeks CS if <32 weeks
26
Patient with severe pre-eclampsia at 35 weeks weeks, what will be your next step?
1. stabilize mother | 2. Deliver
27
What are the contraindications to conservative management for patients with severe preeclampsia?
1. Persistent symptoms or severe hypertension 2. Eclampsia, pulmonary edema, HELLP syndrome 3. Significant renal dysfunction, coagulopathy 4. Abruption 5. Previable fetus 6. Fetal compromise
28
[Urgent control of Severe HPN] Avoid in women with asthma or CHF
Labetalol
29
[Urgent control of Severe HPN] DOC
hydralazine
30
[Urgent control of Severe HPN] Caution if with MgSO4
Nifedipine PO | Nicardipine
31
[Urgent control of Severe HPN] How will you prepare Nicardipine drip
D5W 90mL + Nicaridipine 10mg via soluset (0.1mg/mL) at 10ugtts/min
32
[Urgent control of Gestational HPN] What is the first line drug?
Methyldopa
33
[Urgent control of Gestational HPN] Can inhibit labor, has synergistic action with MgSO4 in lowering BP
Nifedipine
34
[Urgent control of Gestational HPN] Can cause neonatal thrombocytopenia
Hydralazine
35
[Urgent control of Gestational HPN] can decrease uteroplacnetal blood flow
beta blocker can also increase the risk of fetal growth restriction if started in 1st or 2nd trimester
36
[Urgent control of Gestational HPN] Useful in combination with methyldopa and vasodilator to mitigate compesatory fluid retention
Hydrochlorothiazide
37
When will you deliver if patient is having eclampsia?
deliver after seizure Induce labor if cervix is favorable
38
Indication for CS in eclamptic patients?
1. Vaginal delivery does not appear easy and imminent 2. Failure to progress after induction 3. Fetal compromise
39
How will you give MgSO4 if with IM to prevent convulsions?
1. 4g SIVP over 5-10mins 1. 5g deep IM on each buttock 2. 5g IM Total = 19g
40
How will you give Mg SO4 if via IV
1. 4g SIVP 2. Infuse 2g/hr 1L D5W + 20g MgSO4 10mL amp of 50% MgSO4 x 4 to run 2g/hr via infusion pump or soluset
41
What are your MgSO4 precautions?
1. UO at least 30mL/hour or 100mL 4 hours 2. Presence of patellar reflex 4. RR of not <12/min 5. Calcium gluconate at bedside (10mL or 10% solution)
42
[Serum MgSO4 levels] therapeutic range that prevents convulsions
4-7 mEq/L | 4.8 to 8.4mg/dL
43
[Serum MgSO4 levels] patellar reflex disappears
8-10 mEq/L pATEllaer = ATE = Eight
44
[Serum MgSO4 levels] prolonged AV conduction
12 mEq/L
45
[Serum MgSO4 levels] respiratory depression
12-15 mEq/L Remember, RR of not <12 as MgSO4 precaution
46
[Serum MgSO4 levels] cardiac arrest
24 mEq/L
47
[other antiseizure drugs for eclampsia] Diazepam preparation
LD: 10mg slow IV Infuse: pNSS 500mL + 40mg Diazepam x 24 hours
48
[other antiseizure drugs for eclampsia] Phenytoin preparation
LD: 1g slow I over 20 mins Infuse: 100mg every 6 hours x 24 hrs
49
[Cardiovascular Disorders] What is the preferred delivery in patients with CV disease?
Vaginal delivery 1. Semirecumbent position with lateral tilt during labor 2. Epidural anesthesia with IV sedation
50
[Cardiovascular Disorders] What are the indications for CS in patients with CV disease?
1. Dilated aortic root >4cm or Aortic aneurysm 2. Acute severe CHF 3. Recent MI 4. Severe symptomatic aortic stenosis 5. Warfarin administration within 2 weeks delivery 6. Need for emergency valve replacement after delivery
51
What is the most common adverse event in patients wit congenital heart disease during pregnancy?
Arrythmia
52
[Asthma] What are the components in assessing asthma severity?
1. Symptoms 2 days/wk 2. Awakenings 2x per mont 3. Control 2days/week 4. Activity None FEV1 >80%
53
[Asthma] Moderate persistent
Symptoms daily Awakening >1/week Control Daily Activity some limitation
54
[Asthma] What is the first line drug for asthma?
Terbutaline
55
[Asthma] preferred low dose ICS
Budesonide
56
[Asthma] preferred LABA
Salmeterol
57
[Asthma] preferred oral corticosteroids?
Prednisode

OBGYN (33 decks)

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