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Obg > PIH > Flashcards

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Now in criteria of severe / mild preclampsia outdated criteria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
Q

Mc organ involved in pih in mother

A

Kidney

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26
Q

Normally in preg what happen to t hellper cells

A

Th1 Dec
Th2 inc

And in females with pih this response is not seen

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27
Q

Mc how of renal disease in pih

A

Glomeruloendotheliosis

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28
Q

Risk factors for pih

A

Primig
Ne paternity
Others

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29
Q

Types of preg which increases the risk of pih

A

Molar
Rh_ve
Twin

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30
Q

Syndromes causing pih

A

Metabolic syndrome X

Apla

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31
Q

Signs and symp of impending eclampsia

A 
Headache 
Oliguria
Eye changes 
   Mc - scotoma 
  Severe papillooedema 
EPI pain
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32
Q

Changes due to htn retinopathy

A

Keith weigner Baker classification

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33
Q

Inci of eclampsia worldwide

A

1 in 1500

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34
Q

Inci of eclampsia in India

A

1-5%

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35
Q

Maternal mortality due to eclampsia in India

A

2-6%

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36
Q

Eclampsia classification

A

Ape
Ipe
Ppe

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37
Q

Most common type of eclampsia

A

Ape

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38
Q

Worst prognosis of eclampsia

A

Ape

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39
Q

MCC of death

A

Ic bleed

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40
Q

MCC of convulsions

A

Cerebral hypoxia

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41
Q

Mc finding in MRI brain

A

Subcortical white matter edema

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42
Q

Doc for eclampsis

A

Mgso4

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43
Q

Definitive management of pih

A

Termination

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44
Q

Time of delivery in pih depend on

A

Condition of the patient

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45
Q

Def Management of mild pe

A

Deliver at. 37 weeks by vagina

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46
Q

Def Manag of severe pe

A

Deliver at 34 weeks by vagina

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47
Q

def Manag of eclampsia /helpp

A

Deliver vagina route immediate

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48
Q

In mild pe

A

Anti htn is +/_

49
Q

Severe pe mng

A

Ahtn

Mgso4

50
Q

Antihtn doc

A

Labetalol

51
Q

Labetalol is and dose

A

Alpha and Bela blocker

dose 100mg BD / tid max 300 mg

52
Q

Safe antihtn in preg

A

Alpha methyldopa

Hydrolazine

Nifedipine

Nitroglycerine

Labetalol

Na nitroprusside

53
Q

Safe antihtn in preg

A

Alpha methyldopa

Hydrolazine

Nifedipine

Nitroglycerine

Labetalol

Na nitroprusside

54
Q

Antihtn containdi in preg

A

Acei

Diuretics

Beta blockers

Diazoxide

ARB

55
Q

Dose of Alpha methyldopa

A

250-500mg max 2 gm

56
Q

Doc for chronic htn in preg

A

Labetalol > Alpha methyldopa

57
Q

Doc for htn crisis ( eclampsia

A

Iv labetalol

Then IV hydralazine

Then nifedipine

58
Q

Dose of IV labetalol

A 
20 mg IV 
   Nw 10 min 
40mg 
   Nw. 10 min 
80 mg 
 Nw.  10 min

80 mg

59
Q

Max IV labetalol dose

A

220 mg

60
Q

Iv hydralazine dose

Max dose

A

5-10mg
Iv repeat every 10 min

Max 30 mg

61
Q

Doc of refractory htn

A

Na nitroprusside

62
Q

Management of eclampsia

A

Airway

Mgso4

Iv labetalol

Terminate immediately

63
Q

Is mgso4 antihypertensive

A

No

64
Q

Is mgso4 antiepileptic drug

A

No

65
Q

Moa of mgso4

A

Act in CNS

Block nmda receptor

Cause vd

And blocks ca channel

66
Q

Therapeutic range of mgso4

A

4-7 meq / l

1.8- 3.5 mmol/l

67
Q

Regimes of mgso4

A

Pritchard I’m and IV

Only IV
Sibai
Zuspan

68
Q

Compli of Pritchard

A

Gluteal abcess

69
Q

Mc regime

A

Pritchard

70
Q

Loading dose inn pritchard

A

Iv 4gm (20%)

And I’m 10gn (50%) 5 gm in each buttock

71
Q

Maintenance dose

A

Every 4 hrs 5 gm I’m alt buttock

72
Q

Duration of maintenance dose

A

Till 24 hrs after delivery / last convulsion

73
Q

Factors to be monitored before giving maintenance dise

A

Knee jerk >10

Uo should be >=30ml/hr

RR >= 14

Spo2 >= 96% should be

74
Q

Earliest loss in mgso4/ toxicity

A

Knee jerk

75
Q

Signs and symp of toxicity

A

Slurring

Resp difficulty

Diaphoresis

Resp arrest

Cardiac arrest

76
Q

Resp arrest occurs at

A

15meq/l

77
Q

Cardiac arrest occurs at

A

30meq/l

78
Q

Doc for mgso4 toxicity

A

Ca gluconate

79
Q

Sibai regime dose

Iv load

A

6gm /100ml of ns

In 15-20min

80
Q

Sibai regime maint dose

A

2gm /hr IV

81
Q

Zuspan loading

A

4gm iv

82
Q

Zuspan maintenance

A

1gm /IV

83
Q

Doc for status eclampticus

A

Thiopentone sodium

84
Q

Mc and best predictor for pih

A

Uterine a Doppler

Diastolic notch persistence even after 24 weeks

85
Q

Another predictorv for pih

A

Giants roll over test

Now outdated

86
Q

What is roll over test

A

L Lat to supine
N Dec

Pih inc by 20mmhg

87
Q

Upcoming predictors for pih

A

Pappa Dec in ist tri

Vegf Dec

Plac gf. Dec

88
Q

What does vegf and plac gf do

A

Help in trophoblastic invasion

89
Q

Findings but not predictors

A

Edema

Inc uric acid

Hemoconc

90
Q

Drug to prevent pih

A

Aspirin 75-150mg/day

Ca 2 supplementation dose only when ca is less

91
Q

What has no role in preventing pih

A

Salt rest

Rest

Fish oil

Antioxidants

92
Q

Hellp described by

A

Weinstein

93
Q

Hellp is a compli of

A

Severe preclampsia

94
Q

Bp in most pts who develop hellp t/ f

How many have it normal

A

True

15%

95
Q

Bp in most pts who develop hellp inc t/ f

How many have it normal

A

True

15%

96
Q

Mat mortslity in hellp

A

1.5%

97
Q

Recurrent hellp in subsequent preg

A

2.5%

98
Q

What type of hemolysis seen in hellp

A

Microangiopathic hemolytic Anemia

99
Q

Features of enzymes in hellp due to hemolysis

A

Ldh >= 600iu
Retic count inc
Bilirubin inc
Broken Hb bind to haptoglobin so level is decreased

100
Q

PS features of hemolysis in hellp

A

Burr schisto helmet

101
Q

Other enzymes in hellp

A

Sgot/ sgpt >=70iu/l

Plt <1lakh

102
Q

Criteria for diag hellp

A

Tennesi

103
Q

What type of classification is seen in hellp

And based on what

A

Mississippi

Severity

104
Q

Mississippi 1

A

Severe
Plt <50000
Sgot/sgpt >70
Ldh >= 600

105
Q

Missipi 2

A

Mod
Plt = 50000
Sgot/sgpt>70
Ldh >=600

106
Q

Mississippi 3

A

Mild
Plt >1 lakh
Sgot/sgpt >70
Ldh>=600

107
Q

Mg of hellp > =34weeks

A

Deliver

108
Q

Mg of hellp < 34

A

Cs
Wait 24-48hrs
Then deliver

109
Q

AFL of preg

A

Def of lchad in mom

110
Q

AFL of preg mc in

A

3rd tri

111
Q

Are the signs and symp similar to hellp

A

Yes

112
Q

Other things that are present in AFL of preg that is not seen in an hellp pt

A

Hypoglycemia

Hepatorenal s

Dic

Secon compli like pancreatitis

113
Q

Def mg of AFL of preg

A

Termination

114
Q

Indications for immediate termination

A

Eclampsia

Fetal distress

Uncontrolled BP

Rising serum creat

Hellp

Reversal of ed flow

115
Q

Umbilical a Doppler n preg as preg progresses

A

Systolic and diastolic rise

So sd ratio dec

116
Q

In pih uterine a finding

A

As ratio sd ratio inc

117
Q

If resistance is very high ie absent ed flow

A

Terminate at 34weeks

118
Q

If resistance becomes too high ie reversal of ed flow

A

Immediately terminate

119
Q

Mgso4 indication

A

Severe preclampsia
Eclampsia
Pre term labour
Prevent cerebral palsy ( neuroprotective )

Obg (6 decks)

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