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OBS > PIH > Flashcards

PIH Flashcards

1
Q

HTN in pregnancy - BP value

A

> 140/90 on 2 separate occasion 4 hours apart.

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2
Q

Chronic HTN in pregnancy

A

Previous history of HTN.
HTN woman has conceived.
Inc in BP before 12 weeks of pregnancy

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3
Q

PIH.

A

Normotensive woman has conceived and during pregnancy due to Placental pathology has developed HTN @ 20 weeks.

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4
Q

PIH types.

A

Gestational HTN and Pre eclampsia

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5
Q

Gestational HTN

A

HTN after 20 weeks of pregnancy and normal 12 weeks post pregnancy
No Proteinuria or EOD.

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6
Q

Pre Eclampsia

A

HTN after 20 weeks of pregnancy and normal 12 weeks post pregnancy
Either Proteinuria or EOD is present,

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7
Q

Criteria for proteinuria in Pre Eclampsia

A

> 300 mg / 24 hrs or 30 mg / dl or 0.3 g/ l

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8
Q

Urine Protein : Creatinine ratio for Pre eclampsia

A

0.3

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9
Q

EOD signs in Pre eclampsia

A 
S. creatinine > 1.1
Platelet count < 1 lakh
2X raised Liver enzymes - SGPT and SGOT
Pulmonary edema 
Cerebral or Visual symptoms
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10
Q

Types of pre eclampsia

A

Mild - 140/90 - 160/110 with no EOD

Severe - > 160/110 with EOD

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11
Q

Chronic HTN with superimposed Pre eclampsia

A

HTN on conceiving @ 20 weeks has uncontrolled HTN with signs of EOD and new onset Proteinuria.

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12
Q

Pathogenesis of PIH

A

Failure of Trophoblastic invasion leads to persistence of High resistance maternal spiral arteries in the intervillous space.

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13
Q

Angiogenesis is ___ in normal pregnancy

A

INC

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14
Q

Levels of VEGF and Placental GH are _____ in normal pregnancy

A

Inc

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15
Q

Levels of VEGF and Placental GH are _____ in PIH

A

Dec.

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16
Q

sFlt-1 and endoglin levels are _____ in PIH

A

Inc.

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17
Q

Thromboxane a2 and Prostacyclin levels are _____ in normal pregnancy

A

Dec.

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18
Q

Thromboxane a2 and Prostacyclin levels are _____ in PIH

A

Inc

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19
Q

Pathogenesis of EOD in PIH

A

Placental Ischemia - due to high resistance in maternal spiral arteries less blood comes into IVS so blood flow to fetus is reduced.
Inc inflammatory mediators cause Hemoconcentration and capillary leakage leading to Edema and Platelet dysfunction causing thrombosis in blood vessels leading to EOD.

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20
Q

C/I in PIH.

A

Diuretics - Coz of Hemoconcentration.

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21
Q

Severe Preeclampsia - Pathogenesis.

A

Decreased blood flow to all organs.
Brain - Cerebral hypoxia - Convulsions.
Kidney - Dec RBF - Dec GFR- Inc S. creat, urea and uric acid.
Fetus - IUGR and Dec RBF in fetus - Oliguria and oligohydramnios.

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22
Q

MC organ involved in PIH

A

Kidney

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23
Q

HPE finding of Kidney in PIH

A

Glomeruloendotheliosis.

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24
Q

Risk factor for PIH..

A

Placentomegaly or inc Placental tissue
Extra Chorionic villi seen in twin / molar pregnancy.
Primigravida or New paternity.

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25
Q

Complication of severe pre eclampsia

A

Eclampsia - Generalised tonic clonic seizures.

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26
Q

Antepartum Eclampsia

A

GTCS during pregnancy

MC and worst prognosis

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27
Q

Intrapartum Eclampsia

A

GTCS during Labour

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28
Q

Post partum Eclampsia

A

GTCS after delivery within 48 hrs.

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29
Q

Signs and symptoms of Impending eclampsia

A

Oliguria.
Epigastric pain.
Visual Symptoms.
Headache.

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30
Q

Visual Symptoms in Severe pre eclampsia

A

Scotoma
reversible blindness.
Blurring of vision
Diplopia

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31
Q

MC Visual symptom in Severe pre eclampsia

A

Scotoma.

32
Q

Classification of visual symptoms in HTN retinopathy

A

Keith Wagner Classification.

33
Q

Smoking is _____ in PIH

A

Protective.

34
Q

Tests that can predict PIH

A

Uterine artery doppler - Diastolic notch disappearance
VEGF, PLGH, sFLT-1, Endoglin, NO, Thromboxane a2
Dec urine calcium excretion.

35
Q

Findings in PIH

A

Hemoconcentration.
Oliguria
Inc S. uric acid.

36
Q

Drugs to prevent PIH

A

Aspirin. Heparin.

37
Q

Definitive Mx of PIH

A

TOP @ 37 weeks in Mild and 34 weeks in Severe PIH and immediate TOP in eclampsia or HELLP syndrome.

38
Q

Preferred Mode of delivery in PIH

A

Vaginal > CS . if CS is done epidural > Spinal. GA C/I

39
Q

Medical Mx of Mild PIH

A

Anti Hypertensives. +/-

40
Q

DOC to prevent Convulsion in Eclampsia

A

MgSO4

41
Q

DOC to Rx Convulsions in Eclampsia

A

MgSO4

42
Q

DOC to prevent impending eclampsia.

A

MgSO4

43
Q

A-HTN DOC in PIH

A

Labetalol

44
Q

A-HTN DOC in PE

A

Labetalol

45
Q

A-HTN DOC in Chronic HTN

A

Labetalol > Alpha Methyldopa

46
Q

A-HTN DOC in Hypertensive crisis

A

IV Labetalol > IV Hydralazine.

47
Q

A-HTN DOC in resistance cases in pregnancy

A

Sodium Nitroprusside.

48
Q

C/I A-HTN in Pregnancy

A

ACE and ARBs
Beta blockers.
Diuretics.
Diazoxide.

49
Q

Mx of HTN crisis in pregnancy.

A

IV labetalol > IV Hydralazine > Nifedipine > NTG

Last resort - Sodium Nitroprusside.

50
Q

______ is contraindicated in Asthmatic pts with HTN crisis

A

IV Labetalol.

51
Q

Mx of Eclampsia

A

1st step - Secure AIrway
2nd step - MgSO$
3rd Step - IV labetalol.
4th Step definitive Mx - TOP.

52
Q

MOA of MgSO4 in Eclampsia.

A

Vasodilation NMDA receptors - dec Cerebral hypoxia - reducing convulsions.
Ca ++ blocking.

53
Q

MgSO4 should not be administered with

A

CCBs

54
Q

Prophylactic use of MgSO4

A

Impending eclampsia
Severe Eclampsia
HELLP syndrome.

55
Q

MgSO4 Regimen

A

Pritchards and SIBAI.

56
Q

Pritchard regimen of MgSO4

A

Loading dose - 4gm in 20% solution IV and 10 in 50% solution IM -5gm in each buttock
Maintenance dose - 5 gm in 50% solution in each buttock - every 4 hrs for 24 hrs after delivery or Last convulsion

57
Q

SIBAI regimen of MgSO4

A

IV only
Loading dose = 6 gm iv over 20 mins
Maintenance dose = 2 gm iv.
If convulsion reoccurs = 2-4 gms in 5 mins.

58
Q

Therapeutic range of MgSO4

A

Narrow range
4-7 mEq/L
2-3.5 mmol/L
4.8-8.4 mg/dL

59
Q

Parameters to be checked before MgSO4 loading dose.

A

Knee jerk
Urine output > 30ml/hr
Resp rate > 12/min
SpO2 > 96

60
Q

Signs of MgSO4 toxicity

A

Loss of knee jerk or patellar response
Slurring of speech or diaphoresis.
Resp Depression / Arrest
Cardiac Arrest

61
Q

Sign at MgSO4 at > 12 mEq/L

A

Resp depression

62
Q

Sign at MgSO4 at > 15 mEq/L

A

Resp arrest

63
Q

Sign at MgSO4 at >25 mEq/L

A

Cardiac arrest

64
Q

Antidote for MgSO4 toxicity

A

Calcium Gluconate - 10 ml of 10% Calcium gluconate.

Or Ca Chloride.

65
Q

Absolute C/I of MgSO4

A

Myasthenia gravis and renal failure.

66
Q

Status Eclampticus

A

uncontrolled convulsions in spite of MgSO4 administration.

DOC Thiopentone sodium

67
Q

HELLP syndrome

A

H- hemolysis
EL - Elevated liver enzymes
LP- Low platelet count

68
Q

TENNESSEE criteria

A

LDH - >600 IU
SGOT and SGPT - > 70 IU
Platelet < 1 lakh

69
Q

DDx of HELLP

A

Acute fatty liver of Pregnancy

70
Q

Mx of HELLP

A

Prophylactic use of MgSO4
A-HTN
Definitive Mx- TOP immediate.

71
Q

Umbilical artery doppler in Normal pregnancy

A

S/D < 3

72
Q

Umbilical artery doppler in PIH

A

S/D > 3

73
Q

Absent Diastolic flow in UA doppler.

A

Indication for TOP @ 34 wks.

Indicator for Reversal flow within a week.

74
Q

Reversed Flow in UA doppler

A

Indication for Immediate TOP.

75
Q

Indication for Immediate TOP irrespective of GA

A 
eclampsia 
reversed flow in UA 
HELLP syn 
Fetal distress / Abruptio placenta 
Uncontrolled BP 
inc S. Creat
76
Q

Indication for TOP @ 34 wks.

A

Severe pre eclampsia

Absent diastolic flow in UA doppler.

OBS (13 decks)

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