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OB CLERKSHIP > PREECLAMPSIA (Hypertensive Disorders of Pregnancy) > Flashcards

PREECLAMPSIA (Hypertensive Disorders of Pregnancy) Flashcards

1
Q 
# Define: 
Hypertension in Pregnancy

Severe Hypertension in Pregnancy

A

Hypertension:
SBP ≥140 mm Hg and/or
DBP ≥90 mm Hg |

Severe Hypertension:
SBP ≥160 mm Hg and/or DPB ≥110 mm
Hg |

140
160

90
110

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2
Q

GESTATIONAL HYPERTENSION Refers to hypertension ________ or ________ that develops after ___ weeks of gestation

True gestational hypertension should resolve by ___ weeks postpartum.

A

GESTATIONAL HYPERTENSION Refers to hypertension without proteinuria or other signs/
symptoms of preeclampsia-related end-organ dysfunction that develops after 20 weeks of gestation

True gestational hypertension should resolve by 12 weeks postpartum

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3
Q

Continue statement:

Even without proteinuria, patients who develop severe hypertension or other features of severe disease are _____ ______ ______.

A

Even without proteinuria, patients who develop severe hypertension or other features of severe disease are managed in the same way as those with preeclampsia with severe features

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4
Q

If gestational hypertension persists >12 weeks postpartum, the diagnosis is revised to __________

that was masked by __________

If it resolves postpartum and signs and symptoms of pre-eclampsia did not develop, the diagnosis can be revised to ___________

A

If it persists >12 weeks postpartum, the diagnosis is revised to chronic hypertension that was masked by the physiologic decrease in blood pressure that occurs in early pregnancy

If it resolves postpartum and signs and symptoms of pre- eclampsia did not develop, the diagnosis can be revised to transient hypertension of pregnancy

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5
Q

A multisystem progressive disorder characterized by:|
→ ________
→________

A

A multisystem progressive disorder characterized by:

→ New onset of hypertension and proteinuria; or
→New onset of hypertension and significant end-organ dysfunction with or without proteinuria after 20 weeks of
gestation or postpartum in a previously normotensive woman

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6
Q

CRITERIA FOR THE DIAGNOSIS OF PREECLAMPSIA

A

SBP ≥140mmHg or DBP ≥90mmHg on atleast 2 occasions at least 4 hours apart after 20 weeks of gestation in a previously normotensive patient and the new onset of 1 or more of the following:

  1. Proteinuria, 2. Thrombocytopenia
  2. Serum creatinine elevated
  3. Liver trans aminases
  4. Pulmonary edema
  5. New onset and persistent headache
  6. Visual symptoms

CRITERIA FOR THE DIAGNOSIS OF PREECLAMPSIA

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7
Q

How will you check for Proteinuria in Preeclampsia?

A

Proteinuria ≥0.3 g in a 24-hr urine specimen

or

Protein/ creatinine ratio ≥0.3 (mg/mg) (30 mg/mmol)
(Random Urine Specimen)

Dipstick ≥2+ if a quantitative measurement is unavailable

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8
Q

Platelet count in Preeclampsia

A

Platelet count <100,000/􏰀L

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9
Q

Serum creatinine in preeclampsia

  1. 2.
A

Serum creatinine >1.1 mg/dL (97.2 mol/L) or

doubling of the creatinine concentration in the absence of other renal disease

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10
Q

Liver transaminases in preeclampsia

A

Liver transaminases in preeclampsia at least 2x ULN of the normal

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11
Q

What si Eclampsia?

A

Refers to occurrence of a grand mal seizure in a woman with preeclampsia in the absence of other neurologic conditions that could account for the seizure

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12
Q

Defined as hypertension that precedes pregnancy or is present on at least 2 occasions before the 20th week of gestation or
persists >12 weeks postpartum

A

Chronic Hypertension

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13
Q

When is pre-eclampsia considered as “Superimposed”?

A

when it occurs in a woman with woman with preexisting chronic hypertension

–> worsening or resistant hypertension (acutely), the new onset of proteinuria or a sudden increase in proteinuria, and/or significant new end-organ dysfunction after 20 weeks of gestation or postpartum in a woman with chronic hypertension

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14
Q

State at least 5 risk factors for preeclampsia

A
  1. Nulliparity (+primipaternity)
  2. Preeclampsia in a previous pregnancy
  3. Age >40years or <18years
  4. Family history of preeclampsia
  5. Chronic hypertension
  6. Chronic renal disease
  7. Autoimmune disease (APS,SLE)
  8. Diabetes mellitus (pregestational and gestational)
  9. Multifetal gestation
  10. Obesity
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15
Q

Regardless of precipitation etiology, the cascade of events
leading to the preeclampsia syndrome is characterized by abnormalities that result in:
1.
2.
3.

A
  1. systemic vascular endothelial damage with resultant vasospasm
  2. transudation of plasma
  3. ischemic & thrombotic sequelae
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16
Q

NORMAL TROPHOBLASTIC INVASION vs. ABNORMAL

A
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17
Q

Explain the concept of primipara and primipaternity

A

Women previously exposed to paternal antigens such as prior pregnancy with the same partner are “immunized” against preeclampsia

Multiparous women impregnated by a new consort have an increased risk of preeclampsia

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18
Q

What is the centerpiece of preeclampsia pathogenesis?

A

Endothelial Cell Injury

Protein factors are secreted into the maternal circulation and
provoke activation and dysfunction of the systemic vascular
endothelium –> Injured or activated endothelial cells may produce less nitric
oxide and may secrete substances that promote coagulation
and greater sensitivity to vasopressors

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19
Q

4 Important Aspects of the Pathogenesis of the disease, preeclampsia

A
  1. VASOSPASM
  2. ENDOTHELIAL CELL DAMAGE
  3. INCREASED PRESSOR RESPONSES
  4. ANGIOGENIC & ANTIANGIOGENIC
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20
Q

In increased pressory responses

desribe the role of these shelens in Preeclampsia

Increased sensitivity to angiotensin II

Prostaglandin
Thromboxane A2
Prostacyclin:thromboxane A2 ratio
Nitric Oxide
Endothelins

Need sagutin to para review na rin for physio

A

Inc. sensitivity to Angiotensin II

Endothelia prostacyclin (PGI2) production is lower in preeclampsia

Thromboxane A2 secretion by platelets is increased

Prostacyclin:thromboxane A2 ratio decreases

NO - dec. NO synthase expression

Endothelins - potent vasoconstrictor which is increased in preeclampsia

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21
Q

Proangiogenic vs Antiangiogenic protein

A

Proangiogenic
■ Vascular endothelial growth factor (VEGF)
■ Placental growth factor(PLGF)
Antiangiogenic
■ Soluble Fms-liketyrosinekinase1 (sFlt-1)
■ Soluble endoglin (sEng)

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22
Q

What causes the production of sFlt1 (soluble Fms-like tyrosin kinase 1) and what is its role in preeclampsia?

A

Image

23
Q

Describe the effect of preeclampsia in the cardiovascular system?

A

Increased Cardiac afterload: Hypertension

Decreased Cardiac preload: (d/t diminished volume expansion in pregnancy)

24
Q

What would address the decreased preload in preeclampsia?

A

IV crystalloids

LRS
D5W

25
Q

What causes pulmonary edema in preeclampsia?

A

Extravasation of intravascular fluid into the extracellular space

26
Q

Preeclampsia is frequently accompanied by hemolysis

A

Elevated serum LDH

Reduced haptoglobin

Presence of reticulocytosis, spherocytosis, histiocytosis on
PBS

27
Q

Hallmark of preeclampsia

A

HEMOCONCENTRATION

Vasospasm that follow endothelial activation and leakage of
plasma in the interstitial space

28
Q

Why is there thrombocytopenia?

A

Represents platelet activation and aggregation (kasi naubos na)

29
Q

What is HELLP Syndrome?

A

Hemolysis
Elevated Liver enzymes
Low Platelets

30
Q

What are the effects of preeclampsia to the kidneys?

A

Image

31
Q

What are the effects of preeclampsia to the LIVER?

A
32
Q

What are the effects of preeclampsia to the KIDNEYS?

A
33
Q

What are the effects of preeclampsia to the BRAIN?

A
34
Q

What are the effects of preeclampsia to the VISION?

A
35
Q

Relationship of Preeclampsia and Uteroplacental Perfusion?

A
36
Q

Laboratory tests (when preeclampsia is suspected)

Give the 6 + 1

A
  1. CBC with platelet
  2. Serum creatinine level
  3. Liver chemistries: AST, ALT
  4. Urinary protein determination
  5. 24-hr urine collection for Total Protein
  6. Protein:Creatinine ratio in a random urine specimen

Protein ≥2+ (30 mg/dL) – only used if those mentioned above is not available

37
Q

Give the 3 ways on how you would assess the fetal status?

A

Nonstress test

Biophysical profile

Ultrasound (AF volume and estimate fetal weigh. Why check these? because increased risk of oligohydramnios and fetal growth restriction)

38
Q

Role of utz in preeclampsia?

A

Ultrasound (AF volume and estimate fetal weigh. Why check these? because increased risk of oligohydramnios and fetal growth restriction)

39
Q

What is used for the prediction of preeclampsia?

A

Image

40
Q

Measurement of Angiogenic Factors (Urinary or Plasma)

Its role on prediction

A

Image

41
Q

MOA of Aspirin in the prevention of preeclampsia?

A

Image

42
Q

Dosage of Aspirin for prevention of preeclampsia and when is it given?

A

Low-dose aspirin (60-150 mg daily), 2nd to 3rd trimester

Initiate low-dose aspirin for preeclampsia prevention at ≥12 weeks of gestation, and ideally prior to 16 weeks

43
Q

Dosage of Ca2+ in preeclampsia?

A

In the United States, the RDA for elemental calcium is 1000 mg/day in pregnant and lactating women

44
Q

MOA of Ca2+ in Preeclampsia

A

IMage

45
Q

Management of Preeclampsia

  • Previable pregnancies <24 weeks AOG – __________
  • Pregnancies ≥34 weeks AOG - __________
  • Pregnancies ≥24 weeks and <34 weeks – ___________
A

Management of Preeclampsia

  • Previable pregnancies <24 weeks AOG – termination of pregnancy to reduce the mother’s risk of developing life- threatening morbidity or death
  • Pregnancies ≥34 weeks AOG – delivery for all women with preeclampsia with severe features
  • Pregnancies ≥24 weeks and <34 weeks – expectant management of selected cases
46
Q

T or F

Expectant management of asymptomatic women with preeclampsia with severe features based on blood pressure criteria alone appears to be safe and beneficial to the neonate

A

TRUE

Expectant management of asymptomatic women with preeclampsia with severe features based on blood pressure criteria alone appears to be safe and beneficial to the neonate

Severe hypertension can be controlled with antihypertensive drugs and fetal testing is reassuring

47
Q

Antihypertensive medications are Indicated for women with severe hypertension: SBP ≥160mmHg ____________

Treatment initiated within how many minutes?

A

Antihypertensive medications are Indicated for women with severe hypertension: SBP ≥160mmHg presisting for15 minutes or more

Treatment initiated within 30-60 minutes

48
Q

What is the target BP when giving Antihypertensive Medicine to Preeclampsia Severe?

A

Target BP: Reduced Mean Arterial Pressure by no more than 25% over
two hours to achieve target BP of 130-150 mm Hg systolic and 80-100 mm Hg diastolic

49
Q

All antihypertensive drugs cross the placenta. True or false?

A

True

50
Q

PARTS OF THE INITIAL MANAGEMENT (12-24 hours)

  1. Admission to a Maternal Fetal Unit
  2. Administration of a course of antenatal corticosteroids
  3. Seizure prophylaxis: Magnesium sulfate (DOC)
  4. BP monitoring every 1-2 hours
  5. Laboratory studies
  6. Fluid intake and output monitoring
  7. Assessment of Fetal Well-being
A

PARTS OF THE INITIAL MANAGEMENT (12-24 hours)

  1. Admission to a Maternal Fetal Unit
  2. Administration of a course of antenatal corticosteroids
  3. Seizure prophylaxis: Magnesium sulfate (DOC)
  4. BP monitoring every 1-2 hours
  5. Laboratory studies
  6. Fluid intake and output monitoring
  7. Assessment of Fetal Well-being
51
Q
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OB CLERKSHIP (9 decks)

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