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obstetric - gynecol STEP 2 > pregnancy - hypertension and DM > Flashcards

pregnancy - hypertension and DM Flashcards

1
Q

chronic hypertension in pregnancy - definition

A

BP above 140/90 before the patient becomes pregnant or before 20 wks of gestation.

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2
Q

chronic hypertension in pregnancy - complications

A
  1. Placenta abruption

2. may leads to preeclampsia

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3
Q

chronic hypertension in pregnancy - treatment

A
  1. methyldopa or
  2. labetolol or
  3. nifedipine
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4
Q

Gestationl hypertension - definition

A

BP above 140/90 that starts after 20 gestation. NO proteinuria and no edema

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5
Q

Gestationl hypertension - treatment

A

the patient is treated only during pregnancy with methyldopa or labetolol or nifedipine

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6
Q

preeclampsia - definition

A

new onset hypertension (above 140/90) with either proteinuria or end-organ dysfunction after the 20th week of gestation

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7
Q

preeclampsia - RF

A
  1. chronic hypertension
  2. Renal disease
  3. DM
  4. Autoimmune disease
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8
Q

mild vs severe preeclampsia

A
  1. hypertension: above 140/90 in mild, 160/110 in severe
  2. proteinuria: dipstick 1+ to 2+ (or above 300 mg/1d) in mild, 3+ or abouve 5 grams in severe
  3. edema: hands feet and face in mild, genaralized in severe
  4. only severe affects mental status, vision and liver function
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9
Q

mild preeclampsia treatment

A

if term –> induce delivery
preterm –> betamethasone (lung maturation) and magnesium sulfate (seizure prophyaxis)
(only delivery is definitive treatment)

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10
Q

severe preeclampsia treatment

A
  1. prevent eclampsia (magnesium sulfate)
  2. control BP (hydralazine)
  3. Delivery after 34 wks
    If before: betamethasone and magnesium sulfate
    (only delivery is definitive treatment)
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11
Q

how to distinguish lupus flare from preeclampsia

A

joint pain, malar rash, red blood cell casts, low complement, high ANA

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12
Q

severe features of preeclampsia

A
  1. more than 160/110 (2 times with more than 4 hours aprt)
  2. low platelets
  3. increased creatinine
  4. liver enzymes
  5. pulm edema
  6. visual or cerebral symptom
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13
Q

dyspnea in patients with proeclampsia

A

Pulm edema

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14
Q

how to confirm preeclampsia

A

urine protein/cr ratio 0.3 or more
OR
24 h urine collection with protein more than 300 mg

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15
Q

chronic hypertension with superimposed preeclampsia

A

chonic hypertension AND 1 of the following:

  1. new onset proteinuria or worsening of existing proteinuria at 20 or more wks
  2. sudden worsening of hypertension
  3. signs of end-organ damage
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16
Q

pregnancy related risk due to hypertension - maternal

A
  1. superimposed preeclampsia
  2. postpartum hemorrhage
  3. gestational Diabetes
  4. abruption placentae
  5. C-section
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17
Q

pregnancy related risk due to hypertension - fetal

A
  1. fetal growth restriction
  2. perinatal mortality
  3. preterm delivery
  4. oligohydramnios
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18
Q

eclampsia - definition

A

tonic-clonic seizure occuring in patients with history of preeclampsia (preeclampsia + seizures)

19
Q

eclampsia - treatment

A
  • first stabilize the mother, then deliver the baby

- seizure control should done with magnesim sulfate and BP with hydralazine

20
Q

HELLP syndrome?

A
  1. Hemolysis
  2. elevated liver enzymes
  3. low platelets
21
Q

HELLP syndrome - treatment

A

sam as eclampsia

  • first stabilize the mother, then deliver the baby
  • seizure control should done with magnesim sulfate and BP with hydralazine
22
Q

preeclampsia with severe features - when to deliver

23
Q

HELLP - when to deliver

A

34 or more weeks

or at any gestation age with abnormal fetal testing or severe or worsening maternal status

24
Q

HELLP syndrome - abdominal pain?

A

yes due to liver swelling with distension of the hepatic (Glisson’s capsule)

25
Q

perforated peptic ulcer vs HELLP

A

ulcer has peritonitis and maybe hypotension

26
Q

pregestational diabetes - definition

A

the woman had DM (1 or 2) before she became pregnant

27
Q

pregestational diabetes - complications in mother

A
  1. increased risk for preeclampsia (4 times)
  2. increased risk for spontaneous abortion (2 times)
  3. increased rate of infection
  4. increased pospartum hemorrhage
  5. preterm labot
28
Q

pregestational diabetes - complications in fetal

A
  1. increased risk for congenital anomalies (heart + neural tube defects
  2. macrosomia (which can cause shoulder dystocia)
  3. preterm labor
29
Q

pregestational diabetes - evaluation

A
  1. ECG 2. 24 h urine for baseline renal function (Creatinine clearance, protein) 3. HbA1C
  2. Opthalmologic exam for baseline eye function and assessing the condition of the retina
30
Q

Gestational diabetes?

A

high blood sugar that develops during pregnancy and usually disappears after giving birth

31
Q

Gestational diabetes - complications

A
  1. preterm birth
  2. fetal macrosomia (causes birth injuries)
  3. neonatal hypoglycemia
  4. increased risk (4-10) for mother to develop DM2 after pregnancy
32
Q

Gestational diabetes - evaluation

A
  • routinely screened for between 24-28 wks (GA)
  • glucose load test 1st
  • if it is under 140 there is no gestation diabetes
  • if glucose load test is above 140, then glucose tolerance test is done
  • if 2 up to 4 measurements are abnormal, then is (+)
33
Q

glucose load test

A

nonfasting ingestion of 50 g glucose with a measurement of serum glucose 1h later (lower or higher than 140 mg/dL)

34
Q

glucose tolerance test

A

ingestion of 100 g glucose after fast and fasting blood is taken. Glucose is then measured 3 times at 1, 2 and 3 hours

35
Q

gestational diabetes - treatment

A
  • diabetic diet and exercise (walking) are 1st line (DO NOT TELL THEM TO LOSE WEIGHT)
  • if fails: NPH before bed and aspart before meals
  • if if diet fails and refuse insulin: metformin + glyburide (safe + effective)
  • If DM2: insulin
36
Q

SLE nephritis in pregnancy - clinical manifestations

A
  1. edema
  2. malar rash
  3. arthritis
  4. hematuria
37
Q

SLE nephritis in pregnancy - labs

A
  1. nephritic range of proteinuria
  2. urinalysis with RBC WBC casts
  3. low complement levels
    4 high ANA
38
Q

SLE nephritis in pregnancy - diagnosis

A

renal biopsy

39
Q

SLE nephritis in pregnancy - obstetric complications

A
  1. preterm 2. cesarean
  2. preececlampsis
  3. fetal growth restriction
  4. fetal demise
40
Q

RF of eclampsia

A
  1. preeclampsia
  2. increased maternal age
  3. DM
  4. nulliparity
41
Q

seizures not controlled by MgSO4 - next step

A

phenytoin or diazepam

42
Q

treatment of hypertensive emergency (and definition)

A

definition: more than 160/110 for more than 15 mins
hydralazine (IV) or nifedipine (ORAL –> non if vomiting) or labetolol (be careful with labetolol because it slows the HR
- methyldopa only for chronic use

43
Q

gestation DM - treatment

A

dietary modification –> if fails –> insulin / metformin

44
Q

DM when to screen in pregnancy

A

all in 24-28 weeks –> if RF (obesity, previous genstation DM, previous macrosomic infnat) –> ealry i pregnancy and rescreeened at 24-28 weeks

obstetric - gynecol STEP 2 (22 decks)

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