pregnancy - hypertension and DM Flashcards
chronic hypertension in pregnancy - definition
BP above 140/90 before the patient becomes pregnant or before 20 wks of gestation.
chronic hypertension in pregnancy - complications
- Placenta abruption
2. may leads to preeclampsia
chronic hypertension in pregnancy - treatment
- methyldopa or
- labetolol or
- nifedipine
Gestationl hypertension - definition
BP above 140/90 that starts after 20 gestation. NO proteinuria and no edema
Gestationl hypertension - treatment
the patient is treated only during pregnancy with methyldopa or labetolol or nifedipine
preeclampsia - definition
new onset hypertension (above 140/90) with either proteinuria or end-organ dysfunction after the 20th week of gestation
preeclampsia - RF
- chronic hypertension
- Renal disease
- DM
- Autoimmune disease
mild vs severe preeclampsia
- hypertension: above 140/90 in mild, 160/110 in severe
- proteinuria: dipstick 1+ to 2+ (or above 300 mg/1d) in mild, 3+ or abouve 5 grams in severe
- edema: hands feet and face in mild, genaralized in severe
- only severe affects mental status, vision and liver function
mild preeclampsia treatment
if term –> induce delivery
preterm –> betamethasone (lung maturation) and magnesium sulfate (seizure prophyaxis)
(only delivery is definitive treatment)
severe preeclampsia treatment
- prevent eclampsia (magnesium sulfate)
- control BP (hydralazine)
- Delivery after 34 wks
If before: betamethasone and magnesium sulfate
(only delivery is definitive treatment)
how to distinguish lupus flare from preeclampsia
joint pain, malar rash, red blood cell casts, low complement, high ANA
severe features of preeclampsia
- more than 160/110 (2 times with more than 4 hours aprt)
- low platelets
- increased creatinine
- liver enzymes
- pulm edema
- visual or cerebral symptom
dyspnea in patients with proeclampsia
Pulm edema
how to confirm preeclampsia
urine protein/cr ratio 0.3 or more
OR
24 h urine collection with protein more than 300 mg
chronic hypertension with superimposed preeclampsia
chonic hypertension AND 1 of the following:
- new onset proteinuria or worsening of existing proteinuria at 20 or more wks
- sudden worsening of hypertension
- signs of end-organ damage
pregnancy related risk due to hypertension - maternal
- superimposed preeclampsia
- postpartum hemorrhage
- gestational Diabetes
- abruption placentae
- C-section
pregnancy related risk due to hypertension - fetal
- fetal growth restriction
- perinatal mortality
- preterm delivery
- oligohydramnios
eclampsia - definition
tonic-clonic seizure occuring in patients with history of preeclampsia (preeclampsia + seizures)
eclampsia - treatment
- first stabilize the mother, then deliver the baby
- seizure control should done with magnesim sulfate and BP with hydralazine
HELLP syndrome?
- Hemolysis
- elevated liver enzymes
- low platelets
HELLP syndrome - treatment
sam as eclampsia
- first stabilize the mother, then deliver the baby
- seizure control should done with magnesim sulfate and BP with hydralazine
preeclampsia with severe features - when to deliver
34 week
HELLP - when to deliver
34 or more weeks
or at any gestation age with abnormal fetal testing or severe or worsening maternal status
HELLP syndrome - abdominal pain?
yes due to liver swelling with distension of the hepatic (Glisson’s capsule)
perforated peptic ulcer vs HELLP
ulcer has peritonitis and maybe hypotension
pregestational diabetes - definition
the woman had DM (1 or 2) before she became pregnant
pregestational diabetes - complications in mother
- increased risk for preeclampsia (4 times)
- increased risk for spontaneous abortion (2 times)
- increased rate of infection
- increased pospartum hemorrhage
- preterm labot
pregestational diabetes - complications in fetal
- increased risk for congenital anomalies (heart + neural tube defects
- macrosomia (which can cause shoulder dystocia)
- preterm labor
pregestational diabetes - evaluation
- ECG 2. 24 h urine for baseline renal function (Creatinine clearance, protein) 3. HbA1C
- Opthalmologic exam for baseline eye function and assessing the condition of the retina
Gestational diabetes?
high blood sugar that develops during pregnancy and usually disappears after giving birth
Gestational diabetes - complications
- preterm birth
- fetal macrosomia (causes birth injuries)
- neonatal hypoglycemia
- increased risk (4-10) for mother to develop DM2 after pregnancy
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 (+)
glucose load test
nonfasting ingestion of 50 g glucose with a measurement of serum glucose 1h later (lower or higher than 140 mg/dL)
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
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
SLE nephritis in pregnancy - clinical manifestations
- edema
- malar rash
- arthritis
- hematuria
SLE nephritis in pregnancy - labs
- nephritic range of proteinuria
- urinalysis with RBC WBC casts
- low complement levels
4 high ANA
SLE nephritis in pregnancy - diagnosis
renal biopsy
SLE nephritis in pregnancy - obstetric complications
- preterm 2. cesarean
- preececlampsis
- fetal growth restriction
- fetal demise
RF of eclampsia
- preeclampsia
- increased maternal age
- DM
- nulliparity
seizures not controlled by MgSO4 - next step
phenytoin or diazepam
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
gestation DM - treatment
dietary modification –> if fails –> insulin / metformin
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
