Chapter 8 Hypertension and Pregnancy

Question 1

bp decreases during pregnancy as a result of what?

Answer 1

decreased systemic vascular resistance.

Question 2

during the __ trimester, bp will slowly increase back to baseline but should not be higher than that prepregnancy

Answer 2

3rd trimester

Question 3

__ injury is seen in a small % of pts with preeclapsia and is associated with 2 diseases in pregnancy with high morbidity and mortality. ___ and ___

Answer 3

liver; HELLP syndrome, fatty liver of pregnancy AFLP

Question 4

HELLP syndrome stands for wat?

Answer 4

HELLP:
hemolysis
elevated liver enzymes
low platelets.

Question 5

treatment of HELLP syndrome and acute fatty liver of pregnancy is

Answer 5

delivery

Question 6

preeclampsia triad:

Answer 6

1. edema
2. hypertension
3. proteinuria.
   the classic presentation is of a nulliparous woman in her 3rd trimester.

Question 7

generalized vasoconstriction of preeclampsia can result in decreased blood flow to the placenta, which may manifest as ________, resulting in ___ or __ __.

Answer 7

acute uteroplacental insufficiency, resulting in abruption or fetal hypoxia.

Question 8

acute uteroplacental insufficiency may also be chronic in nature and result in

Answer 8

intrauterine growth restricted fetus (iugr).

Question 9

severe preeclampsia is diagnosed with severely elevated bps.

Answer 9

systolic > 160 mmhg or diastolic blood pressure > 110mmhg

Question 10

about __% of pts with severe preeclampsia develop ___ syndrome

Answer 10

10%, HELLP

Question 11

HELLP syndrome is a subcategory of preeclampsia in which the pt presents with __, __, __

Answer 11

1. hemolysis 2. elevated liver enzymes 3. low platelets.

Question 12

HELLP syndrome is uncommon but patients who experience it decline rapidly, resulting in poor maternal and fetal outcomes. despite careful management, HELLP syndrome results in a high rate of

Answer 12

stillbirth, and neonatal death.

Question 13

preeclampsia most often seen in the ___

Answer 13

3rd trimester.

Question 14

when hypertension is seen early in the 2nd trimester (14-20wks)

Answer 14

hydatiform mole or previously undiagnosed chronic hypertension should be considered.

Question 15

any pt who presents with RUQ pain, epigastric pain, nausea and vomiting in the 3rd trimester should be seen imediately to r/o

Answer 15

HELLP

Question 16

bps elevated above 140/90 are necessary to diagnose gh.

Answer 16

true

Question 17

if patients 24 hr urine protein is <___, then preeclampsia is ruled out

Answer 17

300

Question 18

MILD PREECLAMPSIA

Answer 18

BP: SBP>140 OR DBP >90
PROTEINURIA: >300MG/24H OR >1 TO 2> ON DIPSTICK

Question 19

SEVERE PREECLAMPSIA (BY SYSTEMS)

Answer 19

NEURO: SEVERE HEADACHE ( NOT RELIEVED BY ACETAMINOPHEN, VISUAL CHANGES; SCOTOMATA
CARDIOVASCULAR: SBP >160MMHG OR DBP>110MMHG
PULMONARY: PULMONARY EDEMA
RENAL: ACUTE RENAL FAILURE WITH RISING CREATININE
OLIGURIA=5G OR >3+ ON DIPSTICK
GI: RUQ PAIN
elevation of transaminases, AST and ALT
Heme: hemolytic anemia
Thrombocytopenia: <100,000 platelets/mL
DIC
Fetal: IUGR, abnormal umbilical dopplers

Question 20

hellp syndrome characterized by

Answer 20

rapidly deteriorating liver function and thrombocytopenia.

Question 21

Acute Fatty Liver of pregnancy

Answer 21

1 in 10,000 pregnancies and has high mortality rate.

Question 22

to differentiate aflp from hellp, laboratory tests associated with liver failure such as an elevated___ level, blood glucose

Answer 22

ammonia level.

Question 23

diagnosis of HELLP SYNDROME. labs

Answer 23

HEMOLYtIC ANEMIA
1. schistocytes on peripheral blood smear
2. elevated lactate dehydrogenase
3. elevated total bilirubin
ELEVATED LIVER ENZYMES
1. Iincrease in aspartate aminotransferase.
2. increase in alanine aminotransferase
LOW PLATELETS
thrombocytopenia.

Question 24

women who develop preeclampsia during their first pregnancy will have a ____ recurrence rate in subsequent pregnancies

Answer 24

25-33% recurrence rate

Question 25

low doses of aspirin prior to and during subsequent pregnancies decrase risk of

Answer 25

1. preeclampsia 2. IUGR 3. preterm deliveries.

Question 26

calcium supplementation has also been associated with decreased rates of subsequent preeclampsia

Answer 26

true.

Question 27

chronic hypertension defined as HTN:

Answer 27

1. before conception 2. before 20 weeks gestation 3. persisting more than 6 weeks postpartum.

Question 28

chronic htn increases risk for?

Answer 28

1. iugr, mother is increased risk for superimposed preeclampsia, premature delivery and abruptio placentae.

Question 29

pts with chronic hypertension should have a 1. baseline 24 hr urine collection for creatinine clearance and protein should be obtained. this will help differentiate superimposed preeclampsia from chronic renal disease later in pregnancy. 2. baseline ECG in pts with chronic hypertension to ensure that there is no current cardiac compromise requiring further evaluation. 3. low dose asa may decrease risk of developing superimposed preeclampsia

Answer 29

true

Question 30

superimposed preeclampsia diagnosis:

Answer 30

increase in sbp of 30mmhg or in the sbp of 15mmhg over prepregnancy bp. if 24 hr urine protein because elevated greater than 300mg/24hrs, diagnosis is clearly superimposed preeclampsia; if not, then bp can be managed with increasing dosages of medications.

Question 31

elevated uric acid above __ is used to differentiate preeclampsia from exacerbation of hypertension

Answer 31

6.0-6.5

Question 32

preeclampsia is

Answer 32

1. presence of hypertension >140/90mmHg and 2. proteinuria >300mg/24hrs.

Question 33

preeclampsia incidence

Answer 33

5-6% of all live births, and occurs most commonly in nulliparous women in their 3rd trimester

Question 34

preeclampsia is characterized by

Answer 34

general multiorgan vasospasm that can lead to seizure, stroke, renal failure, liver damage, dic or fetal demise.

Question 35

risk factors for preeclampsia

Answer 35

nulliparity, multiple gestation, chronic hypertension