Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

obgy > PIH > Flashcards

PIH Flashcards

Hypertension in pregnancy

1
Q

Chronic HTN in pregnancy

A

Hypertensive before 20 wks of pregnancy.
Pt htn before pregnancy.
bP doesn’t come back to normal after delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PIH

A

HTN more than 20 wks of pregnancy.
Due to placental pathology.
BP will come back to normal within 12 wks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

GESTATIONAL HTN PREECLAMPSIA

  • Proteinuria
  • End organ damage
A
  • Absent present

* Absent present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

End organ damage

A 
Any one of the following shld be present
 Platelet count less than 1 lakh
 S creatinine more than 1.1
 Liver enzymes raised 2x than normal value
 Presence of cerebral or visual symptoms
 Pulmonary edema.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chronic HTN with superimposed preeclampsia

A

A hypertensive female conceives and suddenly at 20 wks if she notice any one of the following
1 uncontrolled BP
2. New onset proteinuria
3. New onset end organ damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Signs of impending eclampsia in severe preeclampsia pt
Symptoms
Tx

A
  1. epigastric pain ± nausea, vomiting
    Due to formation of subcapsular hematomas causing liver capsule to stretch.
  2. headache which is not responding to usual Tx
    ± dizziness due to cerebral hypoxia
  3. New onset visual disturbance
    Convulsions. Hypertensive retinopathy
    KEITH WAGNER BAKER CLASSIFICATION

Tx: mgso4
Doc for treating and preventing convulsions in a pt with pih.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q 
HELLP SYNDROME
 Pt came with epigastric pain on right upper quadrant pain in third trimester.
H     hemolysis
EL    elevated liver enzymes
LP    low platelet count
A 
HEMOLYSIS   any two of four +
1. On peripheral blood smear: schistocytes/ helmet cells/ burr cells +
2. Serum bilirubin levels ≥ 1.2
3. Decreased haptoglobin 
4. LDH increase ≥ 600 IU.
EL: SGOT & SGPT ≥ 70 IU/L
LP: platelet count< 1 lakh
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk factors for PIH or preeclampsia

A
  • Previous history of preeclampsia/ past history of chr HTN/ family history of HTN
  • Chr kidney disease.
  • Primigravida female
  • New paternity.
  • Diabetes placentomegaly
  • syndromes APLA, metabolic X syndrome
  • Pregnancy twin preg, molar preg, Rh neg preg.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to prevent PIH

A

Aspirin 50 – 150 mg/d
Started from 12 wks of pregnancy not later than 16 wks and continued throughout pregnancy.

Given only to females who have identifiable symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tests to predict preeclampsia

A

Most common uterine A Doppler
Outdated test gaints roll over test
Recent predictors :
Increases :- anti angiogenic factors
Sflt 1
S endoglin
Vasoconstrictors
Thromboxane A2
Decreases :- angiogenic factors
VEGF
Placental gf
Vasodilator
Nitric oxide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of PIH
2 types
1. Non specific management
2. Definitive management or specific

A
    • Use of anti HTN therapy
    • Anti convulsant
    • Termination of pregnancy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PIH CONDITION TOP

  1. mild preeclampsia
  2. severe preeclampsia
  3. impending eclampsia
  4. eclampsia
  5. HELLP SYNDROME
  6. Complication
    • Fetal disturbances
    • Kidney failure
    • Abruptio
A

TOP

  1. ≥ 37 wks
  2. ≥ 34 wks
  3. Immediately top
  4. Immediate top
  5. Immediate top
  6. Immediate top
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anti hypertensive therapy:

  • Most common mode of delivery
  • Indications for cesarean
  • Medication, management of preeclampsia
A
  • vaginal delivery
    1. Epidural analgesia
    2. Catheterization in eclampsia
    3. Cut short 2nd stage by intermediate delivery
    Prophylactic use of forceps or vaccum.
    1. After delivery: methylergometrine is C/I.
  • Poor bischop score
    AEDF
    REDF
  • Oral therapy given if BP ≥ 150/100 but ≤160/110
    IV therapy if BP ≥ 160/110. Hypertensive crisis
    ¶CAN BE GIVEN ¶ CONTRAINDICATED
  • Labetalol * ace inhibitors
  • Methyldopa * losartan
  • Nifedipine * diuretics
  • Hydralozine * all beta
  • Ntg blockers
  • Sodium Except
    Nitroprusside Labetalol.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  1. DOC for PIH:
  2. DOC for hypertensive crisis in preg
  3. DOC for chr. HTN in preg
  4. DOC for refractory HTN in preg
  5. DOC for acute hypertensive crisis in preg
A
  1. Labetalol
  2. IV labetalol max dose 220mg
    Initially give 20 mg.. if not decreased give 40 mg…..80mg……..80mg.
    Labetalol is C/I in asthamatic pts.
    For asthamatic IV hydralozine
  3. Labetalol > methyldopa
  4. sodium nitroprusside usually not given bcz it can lead to cyanide toxicity.
  5. 1st DOC: IV labetalol 220mg
    2nd DOC: IV hydralozine
    Sustained release nifedipine
    IV NTG drip
    Refractory cases: sodium nitroprusside
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. What is eclampsia?
  2. Why seizure?
  3. Which eclampsia has worst prognosis?
A
  1. When a pt with preeclampsia throw generalized tonic clonic seizures.
  2. In eclampsia BP increases……… vasoconstriction……. decrease blood flow in brain…….central hypoxia.
  3. Antepartum eclampsia M.C worst prognosis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q 
#Management of eclampsia
# Definitive management
A

1st step: secure the airway ( mouth gag, O2 by masks, aspirate the secretions)

2nd step: Anti convulsant therapy MgSo4.
3rd step: IV anti HTN like labetalol.
# TOP immediate.

17
Q

MgSo4 role in treating convulsions

A

MgSo4 can prevent convulsions only if thy are due to vasoconstriction bcz of PIH.
Not an anti HTN Drug
*Acts on NMDA receptors in brain… Blocks them….
Cerebral vasodilation….. Decreases cerebral hypoxia…… convulsions treated.
* Blocks ca channel’s. Ca channel blockers shldnt be combined with MgSo4 it can lead to respiratory arrest.

18
Q

Pritchard regime: dose of MgSo4

A 
* Loading dose: 14gms
  IV 4gms 20% solution
  IM 10gms 50% solution. 5gms in left buttock and 
 5gms in right buttock.
* Maintanence dose: 5gms
  IM 5gms 50% in alternate buttocks.
19
Q

Therapeutic range of MgSo4

A 
4 – 7 meq/ L
     Or
2 – 3.5 mmol/L
     Or
4.8 – 8.4 mg/ dl
20
Q

Maintanence dose of MgSo4

A 
Shld be given every 4 hourly
Before each dose check
1. Patellar reflex
2. Urine output
3. RR ≥ 12 breath/ min
4. Spo2 ≥ 96%
If any of these is abnormal donot give maintanence dose.
This dose shld be given till 24 hrs after last convulsion or 24 hrs after delivery.
21
Q

Signs and symptoms of MgSo4 toxicity

Antidote?

A 
1st sign loss of patelar reflex ≥10 meq/L
Slurring of speech, diaphoresis
Resp depression ≥ 12 meq/L
Resp arrest occurs ≥ 15 meq/L
Cardiac arrest occurs ≥ 30meq/L

Antidote: ca gluconate IV 10ml of 10%

obgy (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions