Pregnancy complications Flashcards
Pre-eclamptic symptoms?
Headache
RUQ pain
Proteinuria
Edema
Magnesium sulfate
Magnesium sulfate is first-line seizure prophylaxis in women with pre-eclampsia or eclampsia and is administered intravenously from the time of presentation to postpartum (up to 24 hours postpartum).
Magnesium sulfate toxicity
profound hyporeflexia, oliguria, respiratory depression, and cardiac arrhythmia or arrest.
diagnostic criteria for HELLP syndrome:
laboratory evidence of hemolysis (i.e., low Hb and elevated LDH), elevated AST, and low platelets.
Most women also have hypertension and proteinuria, although these are not required for the diagnosis of HELLP.
Abdominal pain due to stretching of Glisson capsule from hepatic swelling is a common symptom.
Pathophys pre-eclampsia
Abnormal remodeling of the spiral arteries creates narrow vessels instead of large, high-capacity vessels, which leads to placental hypoperfusion.
This causes the release of vasoactive substances by the placenta into the maternal bloodstream that alter systemic endothelial cell function.
Increased vascular tone (systemic vasoconstriction) raises maternal blood pressure to ensure sufficient blood supply to the fetus, and endothelial lesions and release of procoagulants result in microthrombi. These factors lead to organ ischemia and damage, which can manifest with headaches and visual disturbances as seen in this patient due to vasospasms in the CNS.
Antihypertensive treatment in pregnancy
Labetalol, hydralazine
Gestational hypertension
pregnancy-induced hypertension with onset after 20 weeks gestation
Defined as a systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg on 2 separate measurements at least 4 hours apart
Eclampsia may progress to HELLP syndrome T/F
False.
Preeclampsia may progress to the life-threatening HELLP syndrome
Preeclampsia
gestational hypertension with proteinuria, renal insufficiency, thrombocytopenia, evidence of liver damage (e.g., elevated liver enzymes, epigastric pain), pulmonary edema, and/or cerebral edema (headache, visual blurring, vomiting, an altered mental status)
Superimposed preeclampsia
preeclampsia that occurs in a patient with chronic hypertension
Chronic hypertension
hypertension diagnosed < 20 weeks gestation or before pregnancy
HELLP syndrome
a life-threatening form of preeclampsia (HELLP is an acronym: H = hemolysis; EL = elevated liver enzymes; LP = low platelets
Eclampsia
severe form of preeclampsia with convulsive seizures and/or coma
Risk factors for developing placenta previa
Maternal age >35 years old, multiples (twins etc.),
already had a baby,
drug use: cocaine or smoking,
surgery to the uterus that will leave scarring: fibroid removal, c-section etc.
sign and symptoms of placenta previa
Painless bright red bleeding
Normal fetal heart rate
Abnormal fetal position