Pre(eclampsia) Flashcards
What are the types of hypertensive pregnancy disorders
Gestational hypertension: pregnancy-induced hypertension with onset after 20 weeks gestation Defined as a systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg on 2 separate measurements at least 4 hours apart
Chronic hypertension: hypertension diagnosed < 20 weeks gestation or before pregnancy
Preeclampsia: gestational hypertension with proteinuria, renal insufficiency, thrombocytopenia, evidence of liver damage (e.g., elevated liver enzymes, epigastric pain), pulmonary edema, and/or cerebral edema (headache, visual blurring, vomiting, an altered mental status)
Superimposed preeclampsia: preeclampsia that occurs in a patient with chronic hypertension
HELLP syndrome: a life-threatening form of preeclampsia (HELLP is an acronym: H = hemolysis; EL = elevated liver enzymes; LP = low platelets) Eclampsia: severe form of preeclampsia with convulsive seizures and/or coma
Risk factors for gestational hypertension and pre(eclampsia)
General risk factors -Thrombophilia (e.g., antiphospholipid syndrome) -Obesity (BMI ≥ 30) -Age < 20 or > 40 years -African-American race ( neeergers) -Diabetes mellitus or gestational diabetes -Chronic hypertension ( before 20 was gestation or before pregnancy) -Chronic renal disease (e.g., SLE) Pregnancy-related risk factors -Nulliparity -Previous gestational hypertensive disorders -Family history of preeclampsia -Multiple gestation (twins) -Chromosomal anomalies or congenital structural anomalies Hydatidiform moles/molar pregnancy (
Pathophys of gestational hypertensive disorders
Placental hypoperfusion(fibrosed spiral arteries/ abnorm implantation) causes maternal hypertension by releasing infalmm vasoactive subs.
vasoactive subs cause vascular inflammation vasoconstriction and microthrombi formation.
vasoconstriction of kidney vessels→ RAAS→salt ant h20 retention→HTN & water retention
renal glom inflam→leaky→proteinuria
other sx are caused by systemic microthombi, vcons, and water retention
causes of gestational hypertensive diseases
Fetal or placental
Fetal
- Abnormal placental (or trophoblast) implantation or development in the uterus → hypoperfusion of placenta and fetus d/2 defective development of uterine spiral arteries
Maternal
- -Arterial hypertension with systemic vasoconstriction causes placental hypoperfusion → release of vasoactive substances by placenta → ↑ maternal blood pressure to ensure sufficient blood supply of the fetus and worsening hypertension→ Systemic endothelial dysfunction causes placental hypoperfusion → ↑ placental release of factors(VEGF for angioplasty genesis ; ProstoGlandinF)→ endothelial lesions that lead to microthrombosis
Effects of vasoconstriction and microthrombi on organs I’m GHD
Preeclampsia
Kidney
- dysfunction of the glomerular endothelium allowing proteins to pass through into the urine and alter oncotic pressure (PROTEINURIA&;OEDEMA)
- -hypertension induced vasoconstriction of renal arteries (imparted renal function)
Blood
- -Systemic microthrombi and vasoconstriction → overactivation of the coagulation system and platelet consumption(DIC,thrombocytopenia)
- -microangiopathic hemolysis- rbc destruction by microthrombi (ANEMIA)
Eclampsia
Brain
-Hypertension-induced vasoconstriction and endothelial damage → disruption of cerebral microcirculation with microthrombi → vasospasms in the CNS (SEIZURES)
Clinical signs of preeclampsia (Non severe)
- Onset: 90% occur after 34 weeks of gestation
- Usually asymptomatic
- Hypertension: 140/90 mmhg
- Visual disturbances, RUQ or epigastric pain, Rapid development of edema, Proteinuria
Clinical signs of severe preeclampsia
- Severe hypertension (systolic ≥ 160 mmHg/diastolic BP≥ 110mmHg)
- Renal failure :Proteinuria&oliguria
- Headache (cerebral oedema, alarm signal for potentil seizure
- Visual disturbances (e.g., blurred vision, scotoma)
- RUQ or epigastric pain d/2 liver swelling irritating flies on capsule
- Pulmonary edema (sob, frothy pink sputum)
- Cerebral symptoms (e.g., altered mental state, nausea, vomiting, hyperreflexia, clonus)
Clinical sign of HELLP syndrome ( type of severe preeclampsia)
Hemolysis
Elevated liver ez
Low Platelets
- Onset: most commonly > 27 weeks gestation (30% occur postpartum)
- severe Preeclampsia sx usually present (∼ 85%)
- Nonspecific symptoms:
- anemia,
- jaundice, RUQ pain (liver capsule pain; liver hematoma)
- DIC, stroke,
Clinical signs of eclampsia
- Onset: associated with severe preeclampsia (but can be associated with mild preeclampsia)
- CNS warning signs - deterioration w/ headaches -hyperreflexxia -visual changes
- Eclamptic seizures: generalized tonic-clonic seizures/ grand mal (usually self-limited) Eclamptic Seizure w
Dg work up and screening in preeclampsia
Prenatal screening:
- Maternal blood pressure
- Maternal weight
- Maternal urine status (urine dipstick)
Work up
- BP:
- HTN on 2 occasions 4 hrs apart
- 24hr urine collection GOLD for proteinuria
- CBC (RBC, platelets)
- Liver function tests (transaminases)
- Peripheral smear (assess for hemolysis)
- coagulation studies are indicated if HELLP syndrome is suspected (i.e., thrombocytopenia and/or liver function impairment are present)
- Kidney function tests (creatinine)
Criteria for dg of non-severe preeclampsia
- Hypertension (> 140/90 mmHg)
- Proteinuria ≥ 300 mg/24 h
- If proteinuria is absent, at least one of the following must be present:
- Thrombocytopenia
- Impaired renal function
- Impaired liver function
- Visual or neurologic changes
- Pulmonary edema
Criteria for dg of severe preeclampsia
- Severe hypertension
- (> 160 mmHg systolic or > 110 mmHg diastolic)
- Thrombocytopenia < 100,000/μL
- Impaired renal function
- (serum creatinine > 1.1 mg/dL or
- doubling of serum creatinine)
- Impaired liver function (elevated transaminases)
- Pulmonary edema Cerebral or visual symptoms
Criteria for dg of HELLP
H = Hemolysis: ↓ Hemoglobin, ↓ haptoglobin, ↑ LDH, ↑ indirect bilirubin
EL = Elevated Liver enzymes: ↑ AST, ↑ ALT
LP = Low Platelets elow 100,00
Dg criteria for eclampsia
Primarily a clinical diagnosis:
patient with preeclampsia presenting with new-onset grand mal seizures without another causes
What are the procedures for Fetal assessment in pre(eclampsia)
- US
- Fetal growth in relation to gestational age
- Placental implantation
- amniotic fluid omount
- Obstetric Doppler ultrasound: non-invasive method for monitoring placental and fetal blood flow Increased resistance in the uterine arteries with an a_bnormal flow pattern_
- Cardiotocography (CTG): monitor fetal heart rate and uterine contractions (also called electronic fetal monitor)
