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OBGYN > OBAb: Hypertensive Disorder > Flashcards

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
Q

Patient with severe pre-eclampsia at 31 weeks weeks, what will be your next step?

A
  1. Give steroids
  2. Daily evaluation
  3. Delivery if with indications
  4. Deliver at 32 to 34 weeks

CS if <32 weeks

26
Q

Patient with severe pre-eclampsia at 35 weeks weeks, what will be your next step?

A
  1. stabilize mother

2. Deliver

27
Q

What are the contraindications to conservative management for patients with severe preeclampsia?

A
  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
Q

[Urgent control of Severe HPN]

Avoid in women with asthma or CHF

A

Labetalol

29
Q

[Urgent control of Severe HPN]

DOC

A

hydralazine

30
Q

[Urgent control of Severe HPN]

Caution if with MgSO4

A

Nifedipine PO

Nicardipine

31
Q

[Urgent control of Severe HPN]

How will you prepare Nicardipine drip

A

D5W 90mL + Nicaridipine 10mg via soluset (0.1mg/mL) at 10ugtts/min

32
Q

[Urgent control of Gestational HPN]

What is the first line drug?

A

Methyldopa

33
Q

[Urgent control of Gestational HPN]

Can inhibit labor, has synergistic action with MgSO4 in lowering BP

A

Nifedipine

34
Q

[Urgent control of Gestational HPN]

Can cause neonatal thrombocytopenia

A

Hydralazine

35
Q

[Urgent control of Gestational HPN]

can decrease uteroplacnetal blood flow

A

beta blocker

can also increase the risk of fetal growth restriction if started in 1st or 2nd trimester

36
Q

[Urgent control of Gestational HPN]

Useful in combination with methyldopa and vasodilator to mitigate compesatory fluid retention

A

Hydrochlorothiazide

37
Q

When will you deliver if patient is having eclampsia?

A

deliver after seizure

Induce labor if cervix is favorable

38
Q

Indication for CS in eclamptic patients?

A
  1. Vaginal delivery does not appear easy and imminent
  2. Failure to progress after induction
  3. Fetal compromise
39
Q

How will you give MgSO4 if with IM to prevent convulsions?

A
  1. 4g SIVP over 5-10mins
  2. 5g deep IM on each buttock
  3. 5g IM

Total = 19g

40
Q

How will you give Mg SO4 if via IV

A
  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
Q

What are your MgSO4 precautions?

A
  1. UO at least 30mL/hour or 100mL 4 hours
  2. Presence of patellar reflex
  3. RR of not <12/min
  4. Calcium gluconate at bedside (10mL or 10% solution)
42
Q

[Serum MgSO4 levels]

therapeutic range that prevents convulsions

A

4-7 mEq/L

4.8 to 8.4mg/dL

43
Q

[Serum MgSO4 levels]

patellar reflex disappears

A

8-10 mEq/L

pATEllaer = ATE = Eight

44
Q

[Serum MgSO4 levels]

prolonged AV conduction

A

12 mEq/L

45
Q

[Serum MgSO4 levels]

respiratory depression

A

12-15 mEq/L

Remember, RR of not <12 as MgSO4 precaution

46
Q

[Serum MgSO4 levels]

cardiac arrest

A

24 mEq/L

47
Q

[other antiseizure drugs for eclampsia]

Diazepam preparation

A

LD: 10mg slow IV

Infuse: pNSS 500mL + 40mg Diazepam x 24 hours

48
Q

[other antiseizure drugs for eclampsia]

Phenytoin preparation

A

LD: 1g slow I over 20 mins

Infuse: 100mg every 6 hours x 24 hrs

49
Q

[Cardiovascular Disorders]

What is the preferred delivery in patients with CV disease?

A

Vaginal delivery

  1. Semirecumbent position with lateral tilt during labor
  2. Epidural anesthesia with IV sedation
50
Q

[Cardiovascular Disorders]

What are the indications for CS in patients with CV disease?

A
  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
Q

What is the most common adverse event in patients wit congenital heart disease during pregnancy?

A

Arrythmia

52
Q

[Asthma]

What are the components in assessing asthma severity?

A
  1. Symptoms 2 days/wk
  2. Awakenings 2x per mont
  3. Control 2days/week
  4. Activity None

FEV1 >80%

53
Q

[Asthma]

Moderate persistent

A

Symptoms daily
Awakening >1/week
Control Daily
Activity some limitation

54
Q

[Asthma]

What is the first line drug for asthma?

A

Terbutaline

55
Q

[Asthma]

preferred low dose ICS

A

Budesonide

56
Q

[Asthma]

preferred LABA

A

Salmeterol

57
Q

[Asthma]

preferred oral corticosteroids?

A

Prednisode

OBGYN (33 decks)

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