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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
perforated peptic ulcer vs HELLP
ulcer has peritonitis and maybe hypotension
26
pregestational diabetes - definition
the woman had DM (1 or 2) before she became pregnant
27
pregestational diabetes - complications in mother
1. increased risk for preeclampsia (4 times) 2. increased risk for spontaneous abortion (2 times) 3. increased rate of infection 4. increased pospartum hemorrhage 3. preterm labot
28
pregestational diabetes - complications in fetal
1. increased risk for congenital anomalies (heart + neural tube defects 2. macrosomia (which can cause shoulder dystocia) 3. preterm labor
29
pregestational diabetes - evaluation
1. ECG 2. 24 h urine for baseline renal function (Creatinine clearance, protein) 3. HbA1C 4. Opthalmologic exam for baseline eye function and assessing the condition of the retina
30
Gestational diabetes?
high blood sugar that develops during pregnancy and usually disappears after giving birth
31
Gestational diabetes - complications
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
Gestational diabetes - evaluation
- 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
glucose load test
nonfasting ingestion of 50 g glucose with a measurement of serum glucose 1h later (lower or higher than 140 mg/dL)
34
glucose tolerance test
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
gestational diabetes - treatment
- 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
SLE nephritis in pregnancy - clinical manifestations
1. edema 2. malar rash 3. arthritis 4. hematuria
37
SLE nephritis in pregnancy - labs
1. nephritic range of proteinuria 2. urinalysis with RBC WBC casts 3. low complement levels 4 high ANA
38
SLE nephritis in pregnancy - diagnosis
renal biopsy
39
SLE nephritis in pregnancy - obstetric complications
1. preterm 2. cesarean 3. preececlampsis 4. fetal growth restriction 5. fetal demise
40
RF of eclampsia
1. preeclampsia 2. increased maternal age 3. DM 4. nulliparity
41
seizures not controlled by MgSO4 - next step
phenytoin or diazepam
42
treatment of hypertensive emergency (and definition)
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
gestation DM - treatment
dietary modification --> if fails --> insulin / metformin
44
DM when to screen in pregnancy
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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