UW htn (02-18) (1) Flashcards
table. Chronic HTN definition?
sAKS >=140 and/or dAKS >=90 prior to conception or 20 weeks gestation
table. gestational HTN definition?
new onset elevated BP at >= 20 weeks gestation
NO PROTEINURIA or end-organ damage
table. preeclampsia. definition?
new onset elevated BP at >= 20 weeks gestation
AND
proteinuria OR end-organ damage
table. eclampsia. definition?
preeclampsia AND new onset grand mal seizures
table. chronic HTN with superimposed preeclampsia. definition?
chronic HTN AND one of the following:
a) new onset proteinuria or worsening of exiting proteinuria at >=20 weeks gestation
b) sudden worsening of HTN
c) signs of end-organ damage
notes. chronic HTN maternal complications.
Superimposed preeclampsia, Postpartum hemorrhage, Gestational diabetes, Abruption placentae, Cesarean delivery
notes. chronic HTN fetal complications.
Fetal: Fetal growth restriction, Perinatal mortality, Preterm delivery (incr. SVR 1. and arterial stiffness placental dysfunction), Oligohydramnios (Note: poorly controlled diabetes leads to polyhydramnios)
table preeclampsia. risk factors? 5
Nulliparity
Obesity
Preexisting medical condition (eg SLE, chronic HTN)
Multiple gestation
Advanced maternal age
table preeclampsia. again definition.
New onset HTN (sAKS >=140 and/or dAKS >=90) at >20 weeks gestation
AND
Proteinuria OR signs/symptoms of other end organ damage
table preeclampsia. severe features. BP?
Severe HTN (sAKS >=160 and/or dAKS >=110).
table preeclampsia. severe features. PLT?
<100k.
table preeclampsia. severe features. liver?
Elevated transaminases (2x upper limit of normal)
table preeclampsia. severe features. pulmonary?
pulmonary edema
table preeclampsia. severe features. CNS?
visual or cerebral symptoms (eg headache)
table preeclampsia. Mx. If <37 weeks and no severe features?
expectant
table preeclampsia. Mx. If >=37 weeks (or >= 34 weeks with severe features)?
delivery
table preeclampsia. Mx. Severe range BP?
iv labetalol, iv hydralazine, PO nifedipine
UW case buvo hydralazine for rapid Mx. Mehlman irgi sita zymejo
table preeclampsia. Mx. seizures prophylaxis?
MgSO4
Preeclampsia prevention. definition?
new onset HTN and proteinuria and/or end organ damage at >20 weeks gestation
Preeclampsia prevention. high risk factors? 6
Prior preeclampsia
CKD
chronic HTN
DM
multiple gestation
Autoimmune disease
Preeclampsia prevention. moderate risk factors? 3
obesity
advanced maternal age
nullparity
Preeclampsia prevention. prevention?
low-dose aspirin at 12 weeks gestation
Stroke due to preeclampsia. notes. mechanism nr1. coagulation system.
Activation of coagulation system, plt aggregation and vascular microthrombi formation –> cerebral vessel occlusion (ischemic stroke)
Stroke due to preeclampsia. notes. mechanism nr 2. blood floow
dysregulated cerebral blood flow –> inappropriate cerebral vasospasm –> incr. perfusion pressure –> rupture of intracerebral vessels (hemorrhagic stroke)
Stroke due to preeclampsia. notes. what about CT?
most patients with preeclampsia do not require CT scan but those with FOCAL NEUROLOGIC DEFICITS require a CT SCAN OF THE HEAD to evaluate for possible stroke and help guide management.
eclampsia table. CP?
HTN, typically severe (ie SBP>=160 or DBP >= 110)
Seizures, typically tonic-clonic with postictal phase
severe headache
visual disturbances (ie scotoma)
hyperreflexia
proteinuria
eclampsia table. Dx? 2
mainly clinical
Bilateral frontal lobe edema on CT scan of head
eclampsia table. Mx? 3
Mg infusion
antihypertensive agent for severe hypertension
delivery
algorithm of patho of pulmonary edema in pre/eclampsia. mechanism
generalized arterial vasospasm (systemic HTN) –> incr. afterload against which the heart is pumping -> incr. pulmonary capillary pressure –> pulmonary edema
algorithm of patho of pulmonary edema in pre/eclampsia. other 3 mechanisms?
decr. albumin
decr. renal function
incr. vascular permeability
notes. postpartum preeclampsia. onset?
preeclampsia can present in postpartum patients up to 6 weeks after delivery
notes. postpartum preeclampsia. CP?
severe headache in bilateral occipital or frontal regions (most common presentation). this headache does not improve with paracetamol or NSAIDs
anti-HTN drugs during pregnancy. first line drugs? 4
BAB (labetalol)
CCB (nifedipine)
hydralazine
methyldopa
anti-HTN drugs during pregnancy. second line? 2
clonidine
thiazine diuretics
anti-HTN drugs during pregnancy. what contraindicated? 5
ACEI
ATII blockers
direct renin inhibitors
nitroprusside
mineralcorticoid receptor antagonists (spironolactone)
UW. HELLP table. CP? 5
Nausea/vomiting
RUQ pain
Headache
visual changes
HTN
UW. HELLP table. Labs?4
Microangiopathic hemolytic anemia
elevated liver enzymes
thrombocytopenia
+/- proteinuria
UW. HELLP table. Tx? 3
Delivery
MgSO4 for seizure prophylaxis
Antihypertensives
UW. HELLP table. complications 5
Abruptio placentae
Subcapsular liver hematoma
Acute renal failure
pulmonary edema
DIC
UW. Tx of preeclampsia. Drugs antihypertensive 3 groups?
Hydralazine iv
labetalol iv [dont give if bradycardia]
nifedipine PO
UW. Tx of preeclampsia. 3 groups antihypertensive. Indication?
lower BP acutely to decr. stroke risk
UW. Tx of preeclampsia. MgSO4 iv or im - indication?
Prevent or treat eclampti seizure
UW. Tx of preeclampsia.
Methyldopa, a centrally acting adrenoreceptor antagonist, is safe during pregnancy but more appropriate for treating chronic hypertension due to slow onset and relatively low potency.
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