Tuesday, 2-28-Hypertensive disorders in pregnancy (Wootton) Flashcards
maternal risks for HTN in pregnancy?
- MI
- cardiac failure
- CVA
- renal and hepatic failure
fetal complications for HTN in pregnancy?
- fetal growth restriction
- preterm birth
- placental abruption
- stillbirth
- neonatal death
definition of HTN (in mmHg)?
sustained BP higher than 140/90
when is gestational HTN recognized?
when does preeclampsia occur?
gestational HTN recognized after 20 wks gestation
preeclampsia occurs after 20 wks and coexists w/proteinuria
for chronic HTN evaluation, how do you assess for maternal end-organ damage?
CBC glucose CMP 24 hr urine for total protein EKG
for chronic HTN evaluation, how do you assess for fetal well-being?
initial US for accurate dating
screening US
growth US monthly after 28 wks
antepartum fetal testing to begin 32-34 wks gestation
definition of mild HTN (in mmHg)?
BP < 160/110 mmHg
how do you dx preeclampsia? symptoms?
dx: HTN, proteinuria, (edema)
symptoms: scotoma, blurred vision, epigastric and/or RUQ pain, Headache
Laundry list of risk factors for developing preeclampsia?
- age (<20 and >35)
- primigravid
- multiple gestation
- hydatidiform mole
- diabetes
- thyroid disease
- chronic HTN
- renal disease
- collagen vascular disease
- antiphospholipid syndrome
- prior hx of preeclampsia (increased by 18%)
what happens to the following systems with preeclampsia?
Brain:
Heart:
Lungs:
brain–> cerebral edema, possibly fibrinoid necrosis, thrombosis, micro infarcts, and petechial hemorrhages
heart –> absence of normal intravascular volume expansion (3rd spacing), reduction in circulating blood volume
lungs –> noncardiogenic pulm edema
what happens to the following systems with preeclampsia?
liver:
kidneys:
eyes:
liver –> subcapsular hematoma leading to liver rupture, stretching of glisson’s capsule results in RUQ pain
kidneys –> swelling and enlargement of glomerular capillary endothelial cells, narrowing of capillary lumen
eyes –> retinal vasospasm, retinal edema
what is the BP in MILD preeclampsia? Proteinuria? symptoms?
BP is >140/90 but <160/110
proteinuria >300 mg/24 hr urine but <5 gms/24 hr
asymptomatic
what is the BP in SEVERE preeclampsia? Proteinuria? is there oliguria? symptoms?
BP systolic >160 or diastolic >110 (2 occasions 4 hrs apart)
proteinuria of at least 5 gm/24 hr or 3+ protein on 2 random urine dips at least 4 hrs apart
Yes, oliguria (<500 ml in 24 hrs) –> renal insufficiency (serum Cr >1.1)
Symptoms: cerebral or visual disturbances, pulm edema, epigastric or RUQ pain, elevated liver enzymes, thrombocytopenia
exam findings of preeclampsia? lab findings?
exam: Brisk reflexes, clonus, (edema)
lab: Increase —> hematocrit, LDH, AST/ALT, uric acid
also get thrombocytopenia
management of preeclampsia WITHOUT severe features at LESS THAN 37 weeks gestation?
bed rest 2x weekly antepartum testing fetal growth US every 3-4 weeks office visits and lab eval possible hospitalization
management of preeclampsia WITHOUT severe features BETWEEN 37-40 weeks gestation?
- if favorable cervix-induction
- if unfavorable cervix-use cervical ripening agent to begin induction
management of SEVERE preeclampsia?
- immediate hospitalization
- delivery if >34 weeks
- Manage BP w/: Hydralazine, labetalol, nifedipine
- if <37 wks administer corticosteroids and work towards delivery as long as pt and fetus stable
this drug is administered IV for preeclampsia with severe features. It is used for seizure prophylaxis.
MgSO4
concerns with MgSO4 administration? how do you reverse these concerns? how long do you administer MgSO4 after delivery?
can overload and result in resp compromise and cardiac arrest (fluid restriction to prevent overload)
Calcium gluconate to reverse effects
continue for approx 24 hrs after delivery
first thing you do in eclampsia? 1st line tx?
protect the airway
MgSO4
after dx a pt with HELLP, what is the next step in management?
immediate delivery
