Pre Eclampsia and Eclampsia: Apostolakis-Kyrus Flashcards
What percent of pregnancies have HTN?
12-22%
HTN causes what percent of maternal death in US?
17.6%
What are the 4 HTN states of pregnancy?
- Gestational HTn
- Preeclampsia
- superimposed preeclampsia
- eclampsia
- chronic preexisting htn
What is gestational htn?
BP > 140/90 after 20 wks
no proteinuria
normal BP within 12wks postpartum
What percent of women with GHTN develop pre eclampsia?
25%
What is preeclampsia?
BP: >140/90 at >20wks
Proteinuria (0.3 g or more in 24 hour urine, 1+ dip)
What might preeclampsia be associated with?
Visual disturbance
Headache
Epigastric pain
Edema
What are the lab abnormalities in preeclampsia?
Hemolysis
elevted LFTs
Low platelets
(HELLP syndrome)
TEST: what are lab abnormalities in PEcc?
Hemolysis
Low liver enzymes
Platelets
TEST: what is the acronym for PrEc lab abnormalities?
HELLP (Hemolysis, low liver enzymes, platelets)
What is severe preeclampsia?
BP >160/110 on 2 occasions 6 hours apart in bed!
Protein >5g… no longer relevant. 3+ on 2 samples
Oliguria
Creatinine >1.2
SYTEMIC SYMPTOMS: CNS, Pulmonary edema/cyanosis, epigastric pain, HELLP exascerbated
FETAL GROWTH RESTRICTION!
What to watch for in severe PrEcc?
SYTEMIC SYMPTOMS: CNS, Pulmonary edema/cyanosis, epigastric pain, HELLP exascerbated
FETAL GROWTH RESTRICTION!
What questions do you ask in OB history?
Do you have a headache? Black spots? SOB? Chest pain? Abdomen pain?
What is superimposed PrEc?
Preexisting HTN
ADD: proteinuria >300mg/24hrs
sudden increase in proteinuria
onset of headache, black spots in vision, epigastric pain
What is eclampsia?
Seizures
Due to HTN and proteinuria
If seizure happens within 48-72 hours of pregnancy, what is suspected?
Post partum eclampsia
What is effect of eclampsia on fetus?
Fetal death possible
What are risks of pREC?
first baby hx of PREC htn diabetes (25% risk) vacular disease renal disease obese too thin extremities of age black antiphospholipid antibody syndrome
How is PREC pathophys?
Unknown… but:
- abnormal trophoblastic invasion of uterine vessels
- immunologic intolerance of fetus
- maternal CV maladaptations
- dietary deficiency
- genetics
What do you want to look at in blood labs?
Hematocrit: high or low
Lactate dehydrogenase increase=HEMOLYSIS!!!
What do you want to look at in liver labs?
Alanine aminotransferase (AAT) Aspartate aminotransferase (AST) hepatic hemorhage=ab pain!
How often does HELLP occur in PREC?
20%
Increases risk of poor outcomes
Eclampsia can mean what has happened in the brain?
INTRACRANIAL HEMORRHAGE
What can happen to sight in EC/PREC?
Temporary blindness
Severe headache, blurred vision, scotomata, hyperreflexia
What drug can prevent seizur?
Magnesium sulfate
What are fetal presentations of PREC?
Growth restriction
Oligohydramnios
Placental abruption
Heartbeat abnormalities
What is Tx of PREC?
Balance risks Observation Non-stress tests... monitor heart beats of both Ultrasound baby to make sure okay Magnesium sulfate for seizure risk transfer to hospital with
What is the main goal of PREC management?
Prevent seizure with Mg and HTN meds
Protect baby
What drugs are used in maternal HTN?
Hydralazine
Labetalol
