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
