Week 12 THURS Flashcards
Pregnancy/ fetal complications
hypertensive disorders of pregnancy
- chronic hypertenison
- gestastional hypertension
- preeclampsia
- eclampsia
- HELLP syndrome
BP exceeding 140/90 before pregnancy or before 20 weeks gestation on at least 2 occasions, and beyond 12 wks postpartum
chronic hypertension
- New onset of BP exceeding 140/90 in previously normotensive individual after 20 weeks gestation on at least 2 occasions, 4-6hrs apart
- resolves by 12 wks postpartum
gestational hypertension
- new onset hypertension accompanied by proteinuria and/or maternal organ dysfunction that targets the cardiovascular, hepatic, renal and CNS
Preeclampsia
Preeclampsia w/ severe features s/s
- thrombocytopenia
- elevated liver enzymes
- serum creat >1.1
- RUQ or epigastric pain
- pulmonary edema
- persistent cerebral or visual disturbances
patho for preeclampsia
1st stage: widespread vasospasm
- Endothelial injury occurs leading to platelet adherence, fibrin deposition, presence of schistocytes (fragments of erythrocytes)
- Results in elevated BP, reduced blood flow to brain, liver, kidneys, placenta and lungs
2nd stage: woman’s response to abnormal placentation when symptoms appear
complications of preeclampsia
- placental abruption
- AKI
- cerebral hemorrhage
- hepatic failure or rupture
- pulmonary edema
- DIC
preeclampsia risk factors
- preeclamsia in previous pregnancy
- chronic hypertension
- vascular change
- multifetal gestation
- nulliparity> first baby
Therapeutic Management of preeclampsia
- monitor BP 4-6hrs
- listen to lung sounds at least 2 hours for pulmonary edema
- low dose aspirin
- CBC, clotting factors, liver enzymes, plt levels
- daily kick counts & fetal mov’t
- increase water intake
- prevent disease progression
Medication management of preeclampsia and HTN
- mag sulfate
- labetalol
- nifedipine
- furosemide
-hydralazine
onset of seizure activity in a woman w/ preeclampsia that cannot be attributed to other cause
Eclampsia
The therapeutic range for magnesium sulfate
4-7 mEq/L
What is the reversal for magnesium sulfate toxicity
calcium gluconate
- have on hand at all times!
- severe form of preeclampsia/eclampsia
- Hemolysis, elevated liver enzymes, low platelet count
HELLP syndrome
HELLP management
lowering BP w/ rapid acting antihypertensives agents, prevention of convulsions or further seizures w/ mag sulfate, steriods for fetal lung maturity
