PR3152 IC17 (el)

Question 1

define hypertension (and severe hypertension) in pregnancy

Answer 1

SBP >140, DBP>90 for >1 measurement, taken at least 4 hours apart

Severe HTN: SBP>160, DBP>110

Question 2

what are the 4 categories of HTN in pregnancy

Answer 2

chronic HTN

gestational HTN

preeclampsia

chronic HTN with superimposed preeclampsia

Question 3

what is chronic HTN

Answer 3

preexisting or new onset hypertension that exists before 20 wks

Question 4

what is gestational HTN

Answer 4

new onset HTN without proteinuria after 20 weeks

Question 5

what is preeclampsia (HTN)

Answer 5

new onset HTN (after 20 weeks) with any of the following
- proteinuria
- uteroplacental dysfunction
- end organ damage

Question 6

what is chronic HTN with superimposed preeclampsia

Answer 6

new onset proteinuria in women
with
chronic hTN without proteinuria before 20 weeks gestation

Question 7

diagnosis of preeclampsia

Answer 7

proteinuria
- UACR > 0.3mg/dL
- 24h urinary protein test ≥300mg
- dipstick protein ≥2

end organ damage
- neurological dysfunction eg seizures, altered mental status, headache w/w/o disturbance
- platelet count <100
- doubling of SCr without other signs of renal damage
- LFTs > 2x ULN
- pulmonary edema

Question 8

description and progression of preeclampsia

Answer 8

involves multi organ damage

may progress to eclampsia: tonic-clonic, focal, multifocal seizures superimposed on preeclampsia

Question 9

what is the prevention method for preeclampsia including dosing regimen

Answer 9

low dose aspirin at least 100mg OD
moa unknown, thought to be due to increase uteroplacental blood flow by reducing thromboxane and restoring the thromboxane-prostaglycin balance

should be started at 12 weeks, by 16 weeks until delivery

Question 10

when should preeclampsia treatment be initiated

Answer 10

HIGH RISK patients with
- multifetal gestation
- history of HTN during pregnancy
- DM
- CKD
- autoimmune disease

Question 11

what are the treatment options for HTN in pregnancy and list pros and cons + when to initiate

Answer 11

initiate as long as >140/90 (goal should be less than that)

methyldopa
- well studied but less used due to decreased potency and side effects: sedation and dizziness

labetalol
- used over b blockers due to less effect on uteroplacental blood flow and fetal growth
- watch for bronchoconstriction and bradycardia

nifedipine
- CCB. also commonly used
- watch for pedal edema, flushing, headache

hydrochlorothiazide
- not first line due to potential interference with normal blood volume expansion during pregnancy

hydralazine
- not used due to mimicking symptoms of preeclampsia and imminent eclampsia ie N/V palpitation, flushing, headache, tremors