Pre Eclampsia and Eclampsia: Apostolakis-Kyrus

Question 1

What percent of pregnancies have HTN?

Answer 1

12-22%

Question 2

HTN causes what percent of maternal death in US?

Answer 2

17.6%

Question 3

What are the 4 HTN states of pregnancy?

Answer 3

1. Gestational HTn
2. Preeclampsia
3. superimposed preeclampsia
4. eclampsia
5. chronic preexisting htn

Question 4

What is gestational htn?

Answer 4

BP > 140/90 after 20 wks
no proteinuria
normal BP within 12wks postpartum

Question 5

What percent of women with GHTN develop pre eclampsia?

Answer 5

25%

Question 6

What is preeclampsia?

Answer 6

BP: >140/90 at >20wks

Proteinuria (0.3 g or more in 24 hour urine, 1+ dip)

Question 7

What might preeclampsia be associated with?

Answer 7

Visual disturbance
Headache
Epigastric pain
Edema

Question 8

What are the lab abnormalities in preeclampsia?

Answer 8

Hemolysis
elevted LFTs
Low platelets
(HELLP syndrome)

Question 9

TEST: what are lab abnormalities in PEcc?

Answer 9

Hemolysis
Low liver enzymes
Platelets

Question 10

TEST: what is the acronym for PrEc lab abnormalities?

Answer 10

HELLP (Hemolysis, low liver enzymes, platelets)

Question 11

What is severe preeclampsia?

Answer 11

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!

Question 12

What to watch for in severe PrEcc?

Answer 12

SYTEMIC SYMPTOMS: CNS, Pulmonary edema/cyanosis, epigastric pain, HELLP exascerbated

FETAL GROWTH RESTRICTION!

Question 13

What questions do you ask in OB history?

Answer 13

Do you have a headache?
Black spots? 
SOB? 
Chest pain?
Abdomen pain?

Question 14

What is superimposed PrEc?

Answer 14

Preexisting HTN

ADD: proteinuria >300mg/24hrs
sudden increase in proteinuria

onset of headache, black spots in vision, epigastric pain

Question 15

What is eclampsia?

Answer 15

Seizures

Due to HTN and proteinuria

Question 16

If seizure happens within 48-72 hours of pregnancy, what is suspected?

Answer 16

Post partum eclampsia

Question 17

What is effect of eclampsia on fetus?

Answer 17

Fetal death possible

Question 18

What are risks of pREC?

Answer 18

first baby
hx of PREC
htn
diabetes (25% risk)
vacular disease
renal disease
obese
too thin
extremities of age
black
antiphospholipid  antibody syndrome

Question 19

How is PREC pathophys?

Answer 19

Unknown… but:

1. abnormal trophoblastic invasion of uterine vessels
2. immunologic intolerance of fetus
3. maternal CV maladaptations
4. dietary deficiency
5. genetics

Question 20

What do you want to look at in blood labs?

Answer 20

Hematocrit: high or low

Lactate dehydrogenase increase=HEMOLYSIS!!!

Question 21

What do you want to look at in liver labs?

Answer 21

Alanine aminotransferase (AAT)
Aspartate aminotransferase (AST)
hepatic hemorhage=ab pain!

Question 22

How often does HELLP occur in PREC?

Answer 22

20%

Increases risk of poor outcomes

Question 23

Eclampsia can mean what has happened in the brain?

Answer 23

INTRACRANIAL HEMORRHAGE

Question 24

What can happen to sight in EC/PREC?

Answer 24

Temporary blindness

Severe headache, blurred vision, scotomata, hyperreflexia

Question 25

What drug can prevent seizur?

Answer 25

Magnesium sulfate

Question 26

What are fetal presentations of PREC?

Answer 26

Growth restriction
Oligohydramnios
Placental abruption
Heartbeat abnormalities

Question 27

What is Tx of PREC?

Answer 27

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

Question 28

What is the main goal of PREC management?

Answer 28

Prevent seizure with Mg and HTN meds

Protect baby

Question 29

What drugs are used in maternal HTN?

Answer 29

Hydralazine

Labetalol