Preg HTN Flashcards
hypertension defined as
BP > 140/90
basic underlying pathology of HTN in pregnancy
vasospasm or arteriolar constriction
Chronic hypertension
HTN present before conception or before 20 weeks gestation and continues for more than 6-12 weeks postpartum
chronic hypertension with superimposed pre-eclampsia
worsening hypertension or worsening proteinuria in the last half of pregnancy
pregnancy induced hypertension (PIH)
hypertension detected for the first time after mid-pregnancy (20 weeks) distinguished from pre-eclampsia by the absence of proteinuria
transient hypertension
usually develops between midpregnancy and 48 hours after delivery but resolves by 12 weeks postpartum
chronic hypertension and pregnancy induced hypertension are treated the same way
monthly US, serial BP and urine protein tests, and weekly non-stress tests during the 3rd trimester medication only given if severe: Methyldopa (first choice) Lebetalol (alternative)
pre-eclampsia definition involves what?
presence of edema, proteinuria, and hypertension may develop any time after 20 weeks gestation, but typically seen in the 3rd trimester ~sometimes can occur up to 6 weeks postpartum -involves generalized arteriolar vasoconstriction and intravascular depletion
most common risk factor for pre-eclampsia
nulliparity
other risk factors for pre-eclampsia
-Extremes of age ( 35 yrs) -Multiple gestations -Diabetes -Preexisting renal disease -Chronic HTN
maternal complications related to pre-eclampsia and arteriolar vasoconstriction
-Progression to eclampsia or HELLP syndrome -Renal failure -Oliguria -Thrombocytopenia -DIC -Pulmonary edema -Abruption placentae -Cerebral hemorrhage
fetal complications related to pre-eclampsia and prematurity
IUGR Low birth weight Prematurity Placental abruption Hypoxia Fetal distress Stillbirth
pre-eclampsia diagnosis based on what labs?
Chemistry panel, LFTs, uric acid levels, sterile urine protein, 24-hour urine protein level, CBC, fibrinogen, and PT/PTT are followed
ultimate treatment of pre-eclampsia
-delivery is the ultimate treatment
treatment of mild pre-eclampsia
-delivery should be induced at 37 weeks -until then, Hydralazine or Labetalol can be given for BP management and Betamethasone can be given before 34 weeks to enhance lung development
Blood pressure: -mild pre-eclampsia -severe pre-eclampsia
MILD: >140/90 mm Hg but 160-180 mmHg systolic or > 110 mmHg diastolic on 2 occasions at least 6 hrs apart
Proteinuria: -mild pre-eclampsia -severe pre-eclampsia
MILD >300 mg/24 hr or 1-2+ on dipstick BUT
Uric acid: -mild pre-eclampsia -severe pre-eclampsia
MILD 4.5
Creatinine: -mild pre-eclampsia -severe pre-eclampsia
MILD normal SEVERE elevated
Liver enzymes: -mild pre-eclampsia -severe pre-eclampsia
MILD normal SEVERE elevated AST, ALT, and LDH
signs and symptoms: -mild pre-eclampsia -severe pre-eclampsia
MILD Hyperreflexia Edema of hands and/or face Sudden weight gain SEVERE Headaches Blurred vision Altered consciousness Scotomas Clonus RUQ pain Oliguria Pulmonary edema Thrombocytopenia
Eclampsia definition
Development of seizures (tonic-clonic) in a preeclamptic patient not attributed to any other cause
eclampsia diagnosis
Diagnosis is based on findings of elevated BP, proteinuria, edema, and seizures -Not all patients will have proteinuria
eclampsia treatment
-seizure control and prophylaxis with magnesium sulfate -BP control with hydralazine -once mother is stable, deliver the baby regardless of gestational age
HELLP syndrome -subcategory of what? -patient presentation -uncommon but has a high rate of -PE may reveal -Diagnosis -Treatment
-subcategory of severe pre-eclampsia -Patients present with: Hemolytic anemia, Elevated Liver function tests, Low Platelets -Uncommon, but has a high rate of stillbirth and neonatal death -PE may reveal epigastric pain (d/t liver distention) and progressive Nausea and Vomiting -Diagnosis based on lab findings -Treatment = DELIVERY of the baby
