Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB > Hypertensive states with pregnancy > Flashcards

Hypertensive states with pregnancy Flashcards

1
Q

What are the types of hypertensive disorders during pregnancy?

A
  • gestational hypertension -> hypertension occurring in the second trimester & resolves after delivery
  • pre-eclampsia -> hypertension + proteinuria without/with edema
  • eclampsia -> hypertension + proteinuria + seizures
  • chronic hypertension -> antedating pregnancy or detected before 20 weeks & persistent after 12 weeks potpartum
  • pre-eclampsia superimposed on chronic hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the classifications of pre-eclampsia?

A

MILD
- BP: 140/90 mmhg or more
- Proteinuria: >300mg/24hrs

SEVERE
- BP: 160/110 mmhg
- proteinuria: >5gm/24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is pre-eclampsia characterized?

A

reduced organ perfusion secondary to vasospasm & endothelial activation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the risk factors for pre-eclampsia?

A

1- extremes of maternal age
2- primigravida
3- long birth intervals
4- black races
5- positive family history
6- multifetal pregnancy
7- maternal malnutrition
8- overweight mother
9- systemic illness
10- + past history of pregnancy induced hypertension
11- ART procedures
12- immunological diseases
13- fetal sex (more in males)
14- paternal factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the recurrence rate for pregnancy induced hypertension?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the anatomical pathology in the placenta in case of pre-eclampsia?

A

Early
- failure of trophoblastic invasion of spiral arteries

Late
- acute atherosis: due to accumulation of macrophages -> narrowing lumen -> placenta ischemia
- placental infarction -> insufficiency -> IUGR -> IUFD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the anatomical pathology in the kidney in case of pre-eclampsia?

A

Glomerular endotheliosis with hypertrophy of intra-capillary cells -> decreased GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the anatomical pathology in the liver in case of pre-eclampsia?

A
  • periportal hemorrhage & necrosis
  • subcapsular hemorrhage & necrosis
  • severe: rupture of liver

increased liver enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the anatomical pathology in the CNS in case of pre-eclampsia?

A
  • vasospasm
  • cerebral edema
  • peticheal hemorrhages & thrombi
  • infarction or hemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the clinical picture of pre-eclampsia?

A

ASYMPTOMATIC -> early mild

SYMPTOMATIC -> late, severe, complicated
- persistent headache
- epigastric & right upper abdominal pain
- persistent vomiting
- visual disturbances
- edema of limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the signs of pre-eclampsia upon clinical examination?

A

1- Hypertension
- BP 140/90 or >
- rise of 30mmHg systolic
- rise of 15mmHg diastolic
on 2 or more occasions 6 hours apart
- resolves within 6 weeks after delivery

2- Proteinuria
- urine collection for 24hrs shows > 300mg

3- Edema
- occult: abnormal rate of weight gain
- clinical: in non-dependent areas (hands & feet)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the complications of Pre-eclampsia on the mother?

A

1- HELLP syndrome -> hemolysis, elevated liver enzymes, low platelet count
2- Eclampsia
3- Acute renal failure -> acute tubular necrosis or bilateral renal cortical stenosis
4- Abruptio placentae
5- cardiac failure
6- acute pulmonary edema
7- intra-cranial hemorrhage
8- hepatic rupture
9- DIC
10- retinal detachement & cortical blindness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the fetal complication of pre-eclampsia?

A
  • IUGR
  • IUFD
  • prematurity (iatrogenic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the investigations done for pre-eclampsia?

A

1- urine analysis -> proteinuria, specific gravity, casts
2- serum uric acid -> hyperuricemia early (n = 3-5.5)
3- kidney functions -> blood urea & creatinine
4- liver functions -> HELLP syndrome
5- hematology -> elevated hematocrit, hemolysis
6- coagulation profile
7- fundus examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do we investigate the fetal wellbeing in pre-eclampsia?

A

1- fetal kick count (after 28 weeks)
2- Non-stress test
3- Ultrasound -> fetal weight, amniotic fluid index, biophysical profile
4- doppler ultrasound of umbilical blood flow: early diastolic notch & decreased end blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do we prevent pre-eclampsia in pregnancy?

A

low dose aspirin 75 - 80mg daily
in high risk patients

17
Q

How are mild cases of pre-eclampsia treated?

A
  • mature fetus (>37 weeks) -> deliver
  • preterm -> achieve fetal maturity
    1- antenatal visits twice a week
    2- rest in left lateral position
    3- ample proteins
    4- salt restriction
    5- antihypertensives: a-methyl dopa, labetalol, nifedipine (keep BP 135/85 mmHg)
    6- low dose aspirin 75-81mg
    7- MgSO4 at 24-34 weeks for neuroprotection
    8- corticosteroids at 24-34 weeks for lung maturity
18
Q

What should be done at every prenatal visit for mother with mild pre-eclampsia?

A

Close maternal monitoring
- ask about warning symptoms
- BP, body weight, urine output, hyper-reflexia
- lab assessment: proteinuria, uric acid, liver functions

Close fetal monitoring
- kick count
- non-stress test
- ultrasound
- umbilical artery duplex

if there is any deterioration -> termination of pregnancy

19
Q

How is severe pre-eclampsia managed?

A

Severe PE without complications -> treat like mild but antenatal visits 3 times a week & higher doses of
- oral hypertensives: labetalol, nifedipine, a-methyl dopa
- corticosteroids
- MgSO4

Severe PE with complications -> immediate delivery
1- hospitalization
2- antihypertensives -> parenteral HYDRALAZINE (5mg IV then 5mg every 20 minutes)
-> Labetalol: 10-20-30-40-80mg IV repeated every 20 mins
3- Prophylactic magnesium sulfate (MgSo4): inital dose 4g IV then 1g/hr for 24 hours
4- antepartum corticosteroids
give proper epidural analgesia then
5- if cervix is not ripe -> C section
6- if cervix is ripe -> prostaglandins, AROM, oxytocin -> vaginal delivery
close observation after delivery

20
Q

What are the characteristics of an Eclamptic fit?

A

1- Premonitory stage -> 1/2 min: twitches of face & hands, rolling up of eyes
2- Tonic stage -> 1/2 min: generalized tonic spasm -> opisthotonus -> no respiration -> cyanosis
3- Clonic (dome) stage -> 1/2 - 1 min: tongue may be bitten & breathing is stertorous
4- Coma stage -> patient may recover or fit again

21
Q

How is eclampsia managed?

A

1- General measures
- patient kept in a dark quite room
- patient lies on her left side with head down
- free patent air & O2 given by mask
- urinary catheter inserted to record volume

2- Control fits
- magnesium sulfate: loading dose 4gm IV over 20min then maintenance dose 1gm/hr for 24hrs (desired level is 4-7mEq/L)
- diazepam: IV 5-10mg

3- Control BP -> hydralazine or labetalol parentral

4- immediate delivery -> after controlling fits & BP

5- MgSO4 should be continued for 24hrs after delivery to guard against postpartum fits

22
Q

What are the precautions for magnesium sulfate use?

A

Before giving next dose, check:
1- urine output: not less than 30ml/hr
2- respiratory rate: not less than 16/min
3- patellar reflex must be present

respiratory & cardiac arrest indicate toxicity
- treat with antidote: Calcium gluconate 1gm (10%) 10ml IV slowly over 3-5 mins

OB (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions