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PIH Flashcards

Pathogenesis mg complications

1
Q

In pregnancy bp is regulated by which hormone

A

Progesterone ( smooth muscle relaxant ) causing Dec pvr hence Dec BP

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2
Q

Mainly which BP is maintained

A

Dbp

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3
Q

BP Dec most in which tri

A

2 nd tri

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4
Q

BP Dec more in which position

A 
Supine position ( supine hypotension syndrome ) 
Ivc compression
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5
Q

When do we refer pt as htn

A

BP >= 140/90 on 2occ atleast 4-6hrs apart best 6

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6
Q

In n individual dbp is indicated by

And in preg

A

Muffling /k4

Disappreance of sound k5

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7
Q

When does pih most commonly develop

A

At 20 weeks

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8
Q

Def pih

A

That starts after 20 weeks and comes to normal after 12 weeks if delivery

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9
Q

Preclampsia criteria

A

Proteinuria
Signs of end organ damage
Either one should be present

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10
Q

Proteinuria

A

> =30 mg/DL
=300mg/24hrs
Urinary protein / creatinine >o.3

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11
Q

Proteinuria is always in preg

Glycosuria can be

A

Pathological

Physilogical

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12
Q

Signs of end organ damage

A 
Plt <= 1 lakh
Serum creat >1.1
Inc liver enzymes> 2 times 
Pulm edema 
Cerebral edema
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13
Q

Mild preclampsia def

A

BP > = 140/90
But <160/110
No sign of eod

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14
Q

Severe preclampsia def

A

> = 160/110

Eod+

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15
Q

Now in criteria of severe / mild preclampsia outdated criteria

A

Proteinuria
Oliguria
Iugr

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16
Q

Pathology of pih

A

Lack of

trophoblastic invasion - ie the cytotrophobast replaces the lining of maternal spiral a and converts it into low resistance vessels
P Dec

Hence v Inc in intervillous space

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17
Q

Time of first trophoblastic invasion

A

First at 10-12 weeks

2nd at 16- 18 weeks ..
.higher chances of being incomplete

hence resistance inc and BP inc especially after 20 weeks

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18
Q

What type of placenta is seen in pih

A

Small placenta

Because of Dec in blood in ivs due to inc BP

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19
Q

Big placenta causes

A

Twin
DM
Rh-ve

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20
Q

How does edema appear in pih

A

Placental ischemia causes relase of inflammatory mediators

Cause capillary endothelium leak

Plasma collects in 3rd space

Inside capillary _ hemoconcenteation causes eod

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21
Q

Eod is caused by

A

Hemoconcenteation

Abnormality of platelet functions

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22
Q

Why is diuretics contraindicated in pih

A

Because of hemoconcenteation

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23
Q

Indications of diuretics in pregnancy

A

Lv failure
Raised ICT
Paul edema

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24
Q

Severe preclampsia conseq

A

Convulsions ( Dec CBF )

Dec blood flow to fetus ( iugr ) and oligo

Dec renal flow in mother Dec in gfr
Serum uric acid and creatinine+

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25
Mc organ involved in pih in mother
Kidney
26
Normally in preg what happen to t hellper cells
Th1 Dec Th2 inc And in females with pih this response is not seen
27
Mc how of renal disease in pih
Glomeruloendotheliosis
28
Risk factors for pih
Primig Ne paternity Others
29
Types of preg which increases the risk of pih
Molar Rh_ve Twin
30
Syndromes causing pih
Metabolic syndrome X | Apla
31
Signs and symp of impending eclampsia
``` Headache Oliguria Eye changes Mc - scotoma Severe papillooedema EPI pain ```
32
Changes due to htn retinopathy
Keith weigner Baker classification
33
Inci of eclampsia worldwide
1 in 1500
34
Inci of eclampsia in India
1-5%
35
Maternal mortality due to eclampsia in India
2-6%
36
Eclampsia classification
Ape Ipe Ppe
37
Most common type of eclampsia
Ape
38
Worst prognosis of eclampsia
Ape
39
MCC of death
Ic bleed
40
MCC of convulsions
Cerebral hypoxia
41
Mc finding in MRI brain
Subcortical white matter edema
42
Doc for eclampsis
Mgso4
43
Definitive management of pih
Termination
44
Time of delivery in pih depend on
Condition of the patient
45
Def Management of mild pe
Deliver at. 37 weeks by vagina
46
Def Manag of severe pe
Deliver at 34 weeks by vagina
47
def Manag of eclampsia /helpp
Deliver vagina route immediate
48
In mild pe
Anti htn is +/_
49
Severe pe mng
Ahtn | Mgso4
50
Antihtn doc
Labetalol
51
Labetalol is and dose
Alpha and Bela blocker dose 100mg BD / tid max 300 mg
52
Safe antihtn in preg
Alpha methyldopa Hydrolazine Nifedipine Nitroglycerine Labetalol Na nitroprusside
53
Safe antihtn in preg
Alpha methyldopa Hydrolazine Nifedipine Nitroglycerine Labetalol Na nitroprusside
54
Antihtn containdi in preg
Acei Diuretics Beta blockers Diazoxide ARB
55
Dose of Alpha methyldopa
250-500mg max 2 gm
56
Doc for chronic htn in preg
Labetalol > Alpha methyldopa
57
Doc for htn crisis ( eclampsia
Iv labetalol Then IV hydralazine Then nifedipine
58
Dose of IV labetalol
``` 20 mg IV Nw 10 min 40mg Nw. 10 min 80 mg Nw. 10 min ``` 80 mg
59
Max IV labetalol dose
220 mg
60
Iv hydralazine dose | Max dose
5-10mg Iv repeat every 10 min Max 30 mg
61
Doc of refractory htn
Na nitroprusside
62
Management of eclampsia
Airway Mgso4 Iv labetalol Terminate immediately
63
Is mgso4 antihypertensive
No
64
Is mgso4 antiepileptic drug
No
65
Moa of mgso4
Act in CNS Block nmda receptor Cause vd And blocks ca channel
66
Therapeutic range of mgso4
4-7 meq / l 1.8- 3.5 mmol/l
67
Regimes of mgso4
Pritchard I'm and IV Only IV Sibai Zuspan
68
Compli of Pritchard
Gluteal abcess
69
Mc regime
Pritchard
70
Loading dose inn pritchard
Iv 4gm (20%) And I'm 10gn (50%) 5 gm in each buttock
71
Maintenance dose
Every 4 hrs 5 gm I'm alt buttock
72
Duration of maintenance dose
Till 24 hrs after delivery / last convulsion
73
Factors to be monitored before giving maintenance dise
Knee jerk >10 Uo should be >=30ml/hr RR >= 14 Spo2 >= 96% should be
74
Earliest loss in mgso4/ toxicity
Knee jerk
75
Signs and symp of toxicity
Slurring Resp difficulty Diaphoresis Resp arrest Cardiac arrest
76
Resp arrest occurs at
15meq/l
77
Cardiac arrest occurs at
30meq/l
78
Doc for mgso4 toxicity
Ca gluconate
79
Sibai regime dose | Iv load
6gm /100ml of ns | In 15-20min
80
Sibai regime maint dose
2gm /hr IV
81
Zuspan loading
4gm iv
82
Zuspan maintenance
1gm /IV
83
Doc for status eclampticus
Thiopentone sodium
84
Mc and best predictor for pih
Uterine a Doppler | Diastolic notch persistence even after 24 weeks
85
Another predictorv for pih
Giants roll over test | Now outdated
86
What is roll over test
L Lat to supine N Dec Pih inc by 20mmhg
87
Upcoming predictors for pih
Pappa Dec in ist tri Vegf Dec Plac gf. Dec
88
What does vegf and plac gf do
Help in trophoblastic invasion
89
Findings but not predictors
Edema Inc uric acid Hemoconc
90
Drug to prevent pih
Aspirin 75-150mg/day Ca 2 supplementation dose only when ca is less
91
What has no role in preventing pih
Salt rest Rest Fish oil Antioxidants
92
Hellp described by
Weinstein
93
Hellp is a compli of
Severe preclampsia
94
Bp in most pts who develop hellp t/ f How many have it normal
True 15%
95
Bp in most pts who develop hellp inc t/ f How many have it normal
True 15%
96
Mat mortslity in hellp
1.5%
97
Recurrent hellp in subsequent preg
2.5%
98
What type of hemolysis seen in hellp
Microangiopathic hemolytic Anemia
99
Features of enzymes in hellp due to hemolysis
Ldh >= 600iu Retic count inc Bilirubin inc Broken Hb bind to haptoglobin so level is decreased
100
PS features of hemolysis in hellp
Burr schisto helmet
101
Other enzymes in hellp
Sgot/ sgpt >=70iu/l | Plt <1lakh
102
Criteria for diag hellp
Tennesi
103
What type of classification is seen in hellp | And based on what
Mississippi Severity
104
Mississippi 1
Severe Plt <50000 Sgot/sgpt >70 Ldh >= 600
105
Missipi 2
Mod Plt = 50000 Sgot/sgpt>70 Ldh >=600
106
Mississippi 3
Mild Plt >1 lakh Sgot/sgpt >70 Ldh>=600
107
Mg of hellp > =34weeks
Deliver
108
Mg of hellp < 34
Cs Wait 24-48hrs Then deliver
109
AFL of preg
Def of lchad in mom
110
AFL of preg mc in
3rd tri
111
Are the signs and symp similar to hellp
Yes
112
Other things that are present in AFL of preg that is not seen in an hellp pt
Hypoglycemia Hepatorenal s Dic Secon compli like pancreatitis
113
Def mg of AFL of preg
Termination
114
Indications for immediate termination
Eclampsia Fetal distress Uncontrolled BP Rising serum creat Hellp Reversal of ed flow
115
Umbilical a Doppler n preg as preg progresses
Systolic and diastolic rise | So sd ratio dec
116
In pih uterine a finding
As ratio sd ratio inc
117
If resistance is very high ie absent ed flow
Terminate at 34weeks
118
If resistance becomes too high ie reversal of ed flow
Immediately terminate
119
Mgso4 indication
Severe preclampsia Eclampsia Pre term labour Prevent cerebral palsy ( neuroprotective )

Obg (6 decks)

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