Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GU / GYN & Renal > Clinical Obstetrics: HTN > Flashcards

Clinical Obstetrics: HTN Flashcards

(49 cards)

Start Studying
1
Q

Plasma volume / Blood volume

Normal CV Changes in Pregnancy

A

Increase w/ weeks gestation

Blood volume increases ~60%

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

Red cell mass

Normal CV Changes in Pregnancy

A

Increases w/ weeks gestation

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

Hematocrit

Normal CV Changes in Pregnancy

A

Decreases w/ weeks gestation
* Physiological anemia

Greater increase in plasma volume than red cell mass

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

Heart rate

Normal Physiological Changes in Pregnancy

A

Increases w/ weeks gestation

HR increases 10-15 bpm

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

Stroke volume

Normal Physiological Changes in Pregnancy

A

Increases w/ weeks gestation

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

Cardiac output
* Undetected heart problems may present during pregnancy due to increased demand on heart

Normal Physiological Changes in Pregnancy

A

Increases w/ weeks gestation

Normal CO = 5 L/min; at 20 weeks gestation = 7 L/min

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

Blood pressure

Normal Physiological Changes in Pregnancy

A

Decreases w/ weeks gestation

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

Systemic vascular resistance (SVR)

Normal Physiological Changes in Pregnancy

A

Decreases w/ week gestation
* Vasopressor (Ang II) resistance during pregnancy
* Increased endothelium-dependent factors: NO
* Upregulated by estradiol & vasodilatory prostaglandins (PGI2)

Peripheral vasodilation leads to 25-30% decrease in SVR

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

Hypertensive disorders of pregnancy

A
  • Gestational HTN
  • Preeclampsia
  • Eclampsia
  • Chronic HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SBP >140 or DBP >90 mm Hg
* >20 weeks gestation
* Absence of proteinuria, systemic signs/symptoms

A

Gestational HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  • SBP >140 or DBP >90 mm Hg
  • > 20 weeks gestation
  • Proteinuria with or without signs/symptos
  • Preeclampsia signs/Sx/labs w/o proteinuria
A

Preeclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  • SBP > 140 or DBP > 90
  • Pregestational or <20 wks gestation
A

Chronic HTN

Physiological changes of pregnancy should resolve by 6 weeks postpartum

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

Blood Pressure
* SBP >140 mm Hg OR DBP >90 mm Hg on 2 occasions at least 4 hrs apart after 20 wks gestation in woman w/ previously normal BP
OR
* SBP >160 mm Hg OR DBP >110 mm Hg confirmed within short interval (15 min)

Proteinuria
* >300 mg per 24-hour urine collection
OR
* Protein/creatinine ratio >0.3
OR
* Dipstick reading of 2+ (used only if other quantitative methods not available)

A

Preeclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  • Nulliparity
  • Multifetal gestations (i.e., twins)
  • Chronic HTN
  • Pregestational / gestational diabetes
  • SLE
  • Pregestational BMI >30
  • Antiphospholipid antibody syndrome
  • Maternal age >35 years
  • Kidney disease
  • Thrombophilia
  • Assisted reproductive technology
  • Obstructive sleep apnea

Risk Factors

A

Preeclampsia

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

Two-stage theory of pre-eclampsia

Etiology

A
  • Lack of remodeling of spiral arteriole intima by cytotrophoblasts leading to less capacitance, decreased blood flow, and hypoxia
    * Remodeling normally dilates spiral arterioles, results in lower resistance, greater capacitance, increased blood flow
  • Placental hypoxia damages syncytium
    * Increased maternal oxidative stress and endothelial & immunological dysfunction leading to maternal end-organ damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mediators of preeclampsia

A
  • Hypoxia results in upregulation of sFlt1
  • Increased sFlt1 reduces free VEGF & PIGF
  • Decreased free VEGF & PIGF results in endothelial dysfunction of maternal blood vessel

sFlt1: soluble EGF transporter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Maternal end-organ damage in preeclampsia

A
  • HTN
  • Glomerular dysfunction
  • Proteinuria
  • Brain & liver edema
  • Coagulation abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Preeclampsia

Etiology

A

Vasospasm
* Uterine vessels (two-stage theory)
* Inadequate maternal vascular response to trophoblast-mediated vascular changes
* Endothelial damage
* Hemostasis
* Prostanoid balance
* PGI2:TXA2 balance shifted to favor TXA2
* TXA2 promotes: vasoconstriction; platelet aggregation
* Endothelium-derived factors
* Decreased NO in pts w/ preeclampsia resulting in vasoconstriction
* Lipid peroxide, free radicals & antioxidants
* Increase in preeclampsia resulting in vascular injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Preeclampsia

Pathophysiology

A

Mediated by systemic vasospasm
* Cardiovascular effects
* Hematologic effects
* Neurologic effects
* Pulmonary effects
* Renal effects
* Fetal effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cardiovascular effects of vasospasm

Pathophysiology

Study These Flashcards
A
  • Hypertension
  • Increased CO
  • Increased SVR
21
Q

Hematologic effects of vasospasm

Pathophysiology

Study These Flashcards
A
  • Volume contraction / hypovolemia
  • Elevated hematocrit
  • Thrombocytopenia
  • Microangiopathic hemolytic anemia
  • Third spacing of fluid
  • Low oncotic pressure
22
Q

Neurologic effects of vasospasm

Pathophysiology

Study These Flashcards
A
  • Hyperreflexia
  • Headache
  • Cerebral edema
  • Seizures (eclampsia)
  • PRES radiological findings
23
Q

Pulmonary effects of vasospasm

Pathophysiology

Study These Flashcards
A
  • Capillary leak
  • Reduced colloid osmotic pressure
  • Pulmonary edema
24
Q

Renal effects of vasospasm

Pathophysiology

Study These Flashcards
A
  • Decreased GFR
  • Glomerular endotheliosis
  • Proteinuria
  • Oliguria
  • Acute tubular necrosis
25
Fetal effects of vasospasm | Pathophysiology
* Placental abruption * Fetal growth restriction * Oligohydramnios * Fetal distress * Increased perinetal morbidity & mortality
26
* Headache * Visual changes * Epigastric / RUQ pain | Symptoms
Severe preeclampsia
27
* SBP >160 or DBP >110 * Papilledema * Pulmonary edema | Signs
Severe preeclampsia
28
* Platelets: < 100,000 x 10^9 /L * AST, ALT: elevated (>2x normal) * Serum creatinine: >1.1 mg/dL * Hemolysis * Abnormal coagulation: increased PT, PTT | Labs
Severe preeclampsia
29
Defined as severe preeclampsia with new onset tonic-clonic, focal or multifocal seizures in absence of other causative conditions
Eclampsia | Other cause: epilepsy, cerebral ischemia, intracranial hemorrhage, drugs
30
Eclampsia | Epidemiology
Incidence (US): 1/1,000 deliveries Mortality: 1% developed world; 15% developing world
31
* LDH: >600 IU/L * AST & ALT: >2x ULN * Platelets: < 100,000
HELLP syndrome | HELLP: Hemolysis, Elevated Liver Enzynes, Low Platelets
32
HELLP syndrome | Epidemiology
20% of women with severe preeclampsia * Occurs in young women, early in pregnancy
33
HELLP syndrome | Potential Complications
* Placental abruption * Renal failure * Subcapsular hepatic hematoma * Preterm delivery * Fetal / maternal death * Recurrent preeclampsia
34
Non-severe preeclampsia | Approach to Therapy
Conservative management * Modified bedrest (rest at home; no activity) * BP monitoring 2-3x/day * Call MD if any Sx of headache, visual changes, or decreased fetal movement * Biweekly MD visit * Weekly labs * Biweekly fetal well-being tests (sonogram, NST)
35
Severe preeclampsia | Approach to Therapy
Delivery * Pitocin: induce labor * Magnesium sulfate: prevent seizures * Antihypertensives (some cases)
36
MoA: Pitocin | Severe Preeclampsia Treatment
* Oxytocin stimulates Ca2+-mediated activation of myometrial receptors * Also causes release of Ca2+ from sarcoplasmic reticulum * Activation of Ca2+ receptors induces contraction | Pitocin = oxytocin analog
37
MoA: Magnesium Sulfate | Severe Preeclampsia Treatment
* CNS depression * Mg2+ competes with Ca2+ for calcium channels blocking intracellular flow of Ca2+ needed to initiate neuronal firing * Raises threshold for neuronal triggering of seizure activity * Antagonistic effects of Mg2+ can also affect cerebral endothelium that forms BBB * Decreased cell calcium inhibits endothelial contraction & opening of tight junctions * Increased blood flow to CNS * Small vessel vasodilation
38
* Loss of deep tendon reflexes (DTRs) * Respiratory depression * Cardiac arrest | Symptoms
Magnesium sulfate toxicity * Loss of DTRs: >10 mEq/L * RD: >15 mEq/L * CA: >20 mEq/L | Recommended Mg levels: 4-7 mEq/L; monitor DTRs
39
Indication for antihypertensives in preeclampsia | Approach to Therapy
Severe HTN: SBP >160 or DBP >110
40
Optimal intervention to prevent deaths due to stroke in women with preeclampsia
Blood pressure control
41
First-line antihypertensive agents for preeclampsia | Approach to Therapy
1. Labetalol IV 2. Hydralazine IV 3. Nifedipine PO: if no IV route available
42
MoA: Labetolol | Severe Preeclampsia BP Control
* Non-specific antiadrenergic agent * Alpha1-blocker: vasodilation * Decreases SVR * Beta-blocker: prevents reflex tachycardia * Decreases BP
43
* Flushing * Light headedness * Palpitations * Scalp tingling | Symptoms
Labetolol side effects | Severe Preeclampsia BP Control
44
MoA: Hydralazine | Severe Preeclampsia BP Control
* Activates arteriolar endothelium receptors & induces release of NO * Promotes vasodialtion * Decreases SVR
45
* Reflex tachycardia * Flushing * Nausea * Salt & water retention * Drug-induced SLE | Symptoms
Hydralazine side effects | Severe Preeclampsia BP Control
46
* Reflex tachycardia * Flushing * Nausea * Salt & water retention * Drug-induced SLE | Symptoms
Hydralazine side effects | Severe Preeclampsia BP Control
47
MoA: Nifedipine | Severe Preeclampsia BP Control
* Blocks Ca2+ channels & reduces intracellular Ca2+ in vascular smooth muscle * Prevents contraction of vascular smooth muscle * Promotes vasodilation * Decreases SVR
48
Chronic HTN & superimposed preeclampsia | Approach to Diagnosis
* Chronic HTN * HTN diagnosed pregestation or <20 wks gestation OR * HTN first diagnosed during pregnancy & does not resolve in postpartum period * Superimposed preeclampsia * Preeclampsia w/ Hx of HTN before pregnancy or <20 wks gestation
49
Chronic HTN & superimposed preeclampsia | Approach to Diagnosis
* Chronic HTN * HTN diagnosed pregestation or <20 wks gestation OR * HTN first diagnosed during pregnancy & does not resolve in postpartum period * Superimposed preeclampsia * Preeclampsia w/ Hx of HTN before pregnancy or <20 wks gestation ## Footnote `

GU / GYN & Renal (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions