PreEclampsia-Eclampsia Syndrome

Question 1

What are the signs of magnesium toxicity?

Answer 1

muscle weakness and loss of deep tendon reflexes, nausea and respiratory depression and if in high doses, cardiac arrest is possible

Question 2

How do you restore respiratory function in magnesium toxicity?

Answer 2

calcium gluconate

Question 3

24 hour urine protein values greater than ___ are required for the diagnosis of mild preeclampsia and ___ for severe preeclampsia.

Answer 3

> 300 for mild, >5000 for severe assuming no other defining criteria are present(SBP>160 or DBP>110)

Question 4

What is the hallmark of eclampsia syndrome?

Answer 4

seizure

Question 5

What is the only definitive therapy for preeclampsia?

Answer 5

delivery of the fetus and placenta

Question 6

What is the antihypertensive agent of choice for controlling elevated blood pressures in the acute setting?

Answer 6

hydralazine; labetolol is also used

Question 7

What is the treatment of choice for eclampsia?

Answer 7

Magnesium; valium, hydantoin and barbiturates can be added as second agents or if magnesium is contraindicated

Question 8

What is the therapeutic magnesium level?

Answer 8

4-7mEq/L

Question 9

At what magnesium level does loss of deep tendon reflexes occur?

Answer 9

7-10

Question 10

At what level Mg does cardiac arrest occur?

Answer 10

15

Question 11

What are contraindications to expectant management of severe preeclampsia remote from term(<32)

Answer 11

plts<100,000, inability to control blood pressure with max doses of 2 antihypertensive medications, non reassuring fetal surveillance, liver function test >2 times normal, eclampsia, persistent CNS symptoms and oliguria

Question 12

What is HELLP syndrome?

Answer 12

“hemolysis, elevated liver enzymes, low platelets”; disease process in spectrum of preeclampsia with severe features with symptoms of malaise, anorexia, nausea and vomiting, epigastric pain and progressive jaundice and persistent vomiting late in pregnancy is the major symptom for many women

Question 13

What fetal heart rate tracing is seen in fetal anemia?

Answer 13

tachycardia and sinusoidal pattern

Question 14

What can cause placental abruption?

Answer 14

trauma, tachysystole, hypertension, preeclampsia

Question 15

When is treatment with antihypertensives indicated?

Answer 15

blood pressures persistently greater than 160 systolic and 105 diastolic with a goal to reduce diastolic into safe range of 90-100 to prevent maternal stroke or abruption without compromising uterine perfusion

Question 16

What are associated with increased likelihood in developing preeclampsia?

Answer 16

parity, family history, obesity and chronic hypertension; odds ratio for chronic renal disease is 20:1, for nulliparity, high BMI and age>40 the odds ratio is 3:1, family history is 5:1 and chronic hypertension is 10:!