Preg HTN

Question 1

hypertension defined as

Answer 1

BP > 140/90

Question 2

basic underlying pathology of HTN in pregnancy

Answer 2

vasospasm or arteriolar constriction

Question 3

Chronic hypertension

Answer 3

HTN present before conception or before 20 weeks gestation and continues for more than 6-12 weeks postpartum

Question 4

chronic hypertension with superimposed pre-eclampsia

Answer 4

worsening hypertension or worsening proteinuria in the last half of pregnancy

Question 5

pregnancy induced hypertension (PIH)

Answer 5

hypertension detected for the first time after mid-pregnancy (20 weeks) distinguished from pre-eclampsia by the absence of proteinuria

Question 6

transient hypertension

Answer 6

usually develops between midpregnancy and 48 hours after delivery but resolves by 12 weeks postpartum

Question 7

chronic hypertension and pregnancy induced hypertension are treated the same way

Answer 7

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)

Question 8

pre-eclampsia definition involves what?

Answer 8

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

Question 9

most common risk factor for pre-eclampsia

Answer 9

nulliparity

Question 10

other risk factors for pre-eclampsia

Answer 10

-Extremes of age ( 35 yrs) -Multiple gestations -Diabetes -Preexisting renal disease -Chronic HTN

Question 11

maternal complications related to pre-eclampsia and arteriolar vasoconstriction

Answer 11

-Progression to eclampsia or HELLP syndrome -Renal failure -Oliguria -Thrombocytopenia -DIC -Pulmonary edema -Abruption placentae -Cerebral hemorrhage

Question 12

fetal complications related to pre-eclampsia and prematurity

Answer 12

IUGR Low birth weight Prematurity Placental abruption Hypoxia Fetal distress Stillbirth

Question 13

pre-eclampsia diagnosis based on what labs?

Answer 13

Chemistry panel, LFTs, uric acid levels, sterile urine protein, 24-hour urine protein level, CBC, fibrinogen, and PT/PTT are followed

Question 14

ultimate treatment of pre-eclampsia

Answer 14

-delivery is the ultimate treatment

Question 15

treatment of mild pre-eclampsia

Answer 15

-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

Question 16

Blood pressure: -mild pre-eclampsia -severe pre-eclampsia

Answer 16

MILD: >140/90 mm Hg but 160-180 mmHg systolic or > 110 mmHg diastolic on 2 occasions at least 6 hrs apart

Question 17

Proteinuria: -mild pre-eclampsia -severe pre-eclampsia

Answer 17

MILD >300 mg/24 hr or 1-2+ on dipstick BUT

Question 18

Uric acid: -mild pre-eclampsia -severe pre-eclampsia

Answer 18

MILD 4.5

Question 19

Creatinine: -mild pre-eclampsia -severe pre-eclampsia

Answer 19

MILD normal SEVERE elevated

Question 20

Liver enzymes: -mild pre-eclampsia -severe pre-eclampsia

Answer 20

MILD normal SEVERE elevated AST, ALT, and LDH

Question 21

signs and symptoms: -mild pre-eclampsia -severe pre-eclampsia

Answer 21

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

Question 22

Eclampsia definition

Answer 22

Development of seizures (tonic-clonic) in a preeclamptic patient not attributed to any other cause

Question 23

eclampsia diagnosis

Answer 23

Diagnosis is based on findings of elevated BP, proteinuria, edema, and seizures -Not all patients will have proteinuria

Question 24

eclampsia treatment

Answer 24

-seizure control and prophylaxis with magnesium sulfate -BP control with hydralazine -once mother is stable, deliver the baby regardless of gestational age

Question 25

HELLP syndrome -subcategory of what? -patient presentation -uncommon but has a high rate of -PE may reveal -Diagnosis -Treatment

Answer 25

-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