Preeclampsia Flashcards
Etiology of Pre Ec
Spiral arteries narrowing
Increased uterine vascular resistance, 30-40% dec in uterine flow
Myometrium sm and narrow- responds readily to vasomotor stimuli and vasoconstriction
What is utero placental ischemia
Imbalance of two placental prostaglandins
- increased vascular resistance
- decreased intravascular volume
- intimate detoriation
What are the results of utero placental ischemia
70% flow decrease
IUGR, fetal hypoxia, placental infarction
Prostacyclin
Decreased presser effect in pregnancy Potent vasodilator Inhibits platelet aggregation Decrease uterine activity Increase uteroplacental blood flow
Thromboxane
Stimulates platelet aggregation and vasospasm: vasoconstriction
Increased sensitivity to angiotensin II - HTN
Incre uterine activity
Decreased utero placental blood flow
Increased in preEcl
Severe Pre E
- SBP >160 DBP>100
- > ## 5g/24 hr proteinuria, dip stick +3, +4
What contributes to generalized vasoconstriction
Increased:
Renin, angiotensin, aldosterone, catecholamines
Pre E - cardiac s/s
Hyperdynamic state
Inc: CO, BP, PCWP
Dec: plasma volume (30-40%), COP, plasma protein,
3% pulmonary edema
Na and H2O retention, CHF, cerebral edema
Hemoconcentration due to hypovolemia
Coagulation in Pre E
Low platelets
What does Betamethasone do to coagulation
Immune mechanism that Destroys platelets
Renal/GI
Inc: liver enzyme, GFR, creatine clearance
HELLP: ARF, peri portal hemorrhage, ischemic lesions, swelling and subscapular hematoma of liver
What is the leading cause of death in pre E
ICH
EEG 75% of PE will have abnormal
P50 numbers of oxyHgb
- Non Pregnant
- Normal pregnant
- Preeclamptic pregnant
- 26.7 non pregnant
- 30.1 normal pregnant
- 24.4 Preeclamptic pregnant
What happens to placenta/uterus
Small, infarcted, premature aging, calcification, hyperactive, sensitive to oxytocin
Marginal placental function
Mag function
- Reduces hyper-reflexia and controls convulsions: dec Ach
- Mild vasodilator: depresses catecholamine, release smooth muscle
- Increases prostacyclin production
Mag s/s
- Weakness, resp insufficiency, cardiac failure
- Assess and monitor deep tendon reflexes
- Inc sensitivity to NDMR
- Dec muscle tone in neonates
- Resp depression, apnea at birth
Mag dose
2-4 gm/15 min loading dose
2-4g/hr continuous infusion
Maintain 24-48 hrs after delivery
Maintain blood level of 4-8 mEq/L (normal 1.5-2.0)
Rx of Mg overdose
Mother: 10cc of 10% Ca gluconate over 10 min
Neonate: IV Ca 10gm/dl (10%) .5-1 ml slowly, monitor HR
Ant HTN meds
- Hydralazine: inc utero placental blood flow, long onset time
- Na nipride/NTG : emergent situations only
- Beta blockers:
- labetalol safe for mom
- esmolol crosses placenta barrier - Ca channel blockers
- improve placental/renal perfusion, increases UO
- augment Mg (acts as Ca blocker)
Rx for convulsions
Propofol
Versed or MgSO4 bolus
Mannitol or decadron for cerebral edema
FIRST: Secure airway
Which ant HTN med helps to improve UO
Ca channel blocker
Improves placental blood flow
EKG changes with high Mag
5-10 PQ prolong, QRS widens
10 loss of DTReflexes
Main point for anesthesia
- Coags: b4 regional
- Mag gtts = sensitive to NDMR, no defasiculation dose
- GA: RSI, prop or etomidate, no ketamine, labetalol
What does HELLP stand for
Hemolytic anemia Elevated Liver enzymes Low Platelets
