Pregnancy Flashcards
decrease in svr and increase in arterial compliance is evident by
6 weeks of gestation
Plasma volume in pregnancy
inc 30-50% above baseline
BP in pregnancy
Decrease by 10mmhg below prepregnancy level, nadir in 2nd trimester, gradual inc toward pre pregnancy by term
Cardiac output
increase 30-50%
Heart rate
increase by 15-20 beats per min
Length of kidney
Inc 1-1.5 cm
Renal volume
inc up to 30%
renal blood flow
increase to 80%
GFR
150-200 ml/min, 40-50% baseline
Hgb Crea uric acid pco2 Na Osm
decrease
pH Calcium
increase
new osmotic setpoint in pregnancy
270 mOsn/kg
acid base in pregnancy
respi alk
mediates respi alk response
Progesterone
hormone central to global vasodilatory response specifically to increase in GFR and rbf
relaxin
new onser of hypertension and proteinuria after 20 weeks of gestation
preeclampsia
definitive tx of preeclampsia
delivery of neonate
criteria for hypertension in pregnancy
more than or equal to 140/90 after 20 weeks of gestation on 2 occasions at least 4h apart
more than or equal to 160/105 within minutes
criteria for proteinuria in preeclampsia
More than or equal to 300 mg/24H
protein/crea ratio more than 0.3 mg
dipstick +1
Hallmark of preeclampsia
proteinuria
in the absence of proteinuria, preeclampsia is still considered in patients with new inset htn with any of the ff
thrombocytopenia renal insufficiency impaired lft pulmonary edema cerebral of visual symptoms
threshold for thrombocytopenia in preec
<100k
criteria for renal insufficiency in preec
crea > 1.1 or doubling
sudden inc in woman with chronic htn that was previously controlled or escalation of antihtn to control bp
or
new onset of proteinuria in a whiman with chronic htn or a sudden inc in proteinuria un a woman with known proteinuria before or in early pregnancy
superimposed preeclampsia
oliguria < 500 ml in 24H, persistent headache or visual disturbance, pulmonary edema, epigastric or ruq, elevated lft and thrombocytopenia alone or in hellp
severe preeclampsia
Tx of hus/ttp
plasma exchange
tx of hellp and aflp
supportive care/delivery
generalized swelling and vacuolization of the endothelial cells and loss of capillary space
Glomerular endotheliosis
management: severe preec prior to 24 weeks of gestation
termination of pregnancy
until when do we withold anti hypertensive therapy for precclampsia
bp above 150-160/100-110
mgt hellp 24-34 weeks, stable clinical status with reassuring fetal status
expectant management
history of htn prior to pregnancy or a bp higher than 140/90 prior to 20 weeks
chronic hypertension
hypertension after 20 weeks and resolves after delivery
gestational htn
antihypertensive treatment indicated in chronic htn
severe hypertension > 160/105
first line oral agent
methlydopa
exception among beta blockers which causes fetal growth restriction
atenolol
ace and arbs are contraindicated in what trimester
consequences of acei and arbs
2nd and 3rd trimester - fetal malformations: renal dysgenesis, perinatal renal failure, oligohyramnios, pulmo hypoplasia, hypocalvaria, iugr
antihtn for breastfeeding
methlydopa
enalapril/captopril
labetalol/propranolol
most common cause of aki during pregnancy
hyperemesis gravidarum or vomiting causing prerenal aki
severe and often irreversible form of atn associated with septic abortion and placental abruption
bilateral cortical necrosis
dx of renal cortical necrosis
ct scan - hypodense areas in the renal cortex
liver failure with elevated serum aminotransferase and hyperbilirubinemia
acute fatty liver of pregnancy
swollen hepatocytes filled with microvesicular fat and minimal hepatocellular necrosis
aflp
hemolysis, thrombocytopenia variable organ dysfunction
hus - renal failure
ttp - neurologic
diagnostic and therapeutic trial intervention to confirm dx of obstructive uropathy if clinical suspicion is high
percutaneous nephrostomy
majority of stones in pregnancy
calcium oxalate and calcium phosphate
preferred method to visualize obstruction and stones
ultrasound
mgt for nephrolithiasis
hydration, analgesics, antiemeticw
when can eswl be done in pregnancy
1st 4-8 weeks
nephrolithiasis with uti should be treated with antibx for how long
3-5 weeks
when is suppresive therapy recommended
bacteriuria that persists after 2 courses of therapy
suppressive therapy used
nitrofurantoin or cephalexin
women with sle should postpone pregnancy until lupus activity is quiescent for
6 months
mmf should be replaced by
azathioprine
weekly dialysis dose in esrd on hd pregnant patients
20 or more hours per week
most common complication of pregnancy in transppant recipients
hypertension
agents of choice from post kt htn
methlydopa, labetalol, ccb
basis of immunosuppresion during pregnancy for post kt
cyclosporine or tacrolimus and steroids
dose of steroids and azathioprine considered safe
5-10 mg/day
less than 2 mkd
mainstay of tx of acute rejection during pregnancy
high dose steroid therapy
peripheral vasodilation caused by
estrogen, progesterone and relaxin
relaxes the ureters
progesterone
primary prevention for preeclampsia in women with high baseline risk
aspirin
anti htn with tocolytic properties
nicardipine
mgt of preeclampsia with no severe symptoms
postpone delivery
no anti htn unless sbp > 150-160/100-110
MgSo4
target Mg in preeclampsia
5-9 mg/dL
gold standard for gfr measurement
Inulin or creatinine clearance
hgb target in pregnancy esrd
10-11 g/dL
normal pregnancy weight gain
25-35 lbs
with risk for fetal cyanide poisoining
nitroprusside
when to start aspirin
less than 16 weeks to 34-36 weeks
hd targets in pregnancy
low blood flow 150-250
Low dialysate flow 300
biocompatible dialysis membrane
prehd bun < 50 my/dl or urea < 100 mg/dL
