Exam 3 - Gestational Hypertension and Preeclampsia Flashcards
What is the leading cause of maternal death during pregnancy?
Hypertensive disorders
- Include chronic HTN, gestational HTN, preeclampsia and eclampsia, preeclampsia superimposed
Risk factors for developing hypertensive disorders during pregnancy
- Nulliparity
- Age >35
- African American race
- Obesity
- Family history of preeclampsia or personal history of preeclampsia
- Chronic HTN or renal disease
- Pre-gestational diabetes
- Multiple gestation
- Vascular and connective tissue disease
- Antiphospholipid antibody syndrome
- Abnormal doppler studies at 18 and 24 weeks
- Hydatidiform mole
Complications of hypertensive disorders during pregnancy
- Renal failure
- Liver failure
- Cerebral hemorrhage
- DIC
- Abruptio placentae
- Emergent operative delivery
- Death
What is the fetus at risk for if the mother has a hypertensive disorder?
- Oligohydramnios
- Abruptio placentae
- Intrauterine growth restriction
- Intolerance of labor
- Medically indicated preterm delivery
Is hypertension during pregnancy a unique condition?
Unique human hypertensive disorder; multi-organ systemic condition
- Begins in endothelium through changes in vascular apparatus of placenta
Normally how does the body account for pregnancy changes in relation to blood pressure?
High volume, low pressure coiled spiral arteries are converted to narrow arteries with high pressure which cascade into complications for multiple organs
Preeclampsia: multi-organ systemic condition
- Signs and symptoms
- Headache, seizure, postpartum cerebral vascular disease
- Blurry vision, floaters, blindness
- Pulmonary edema, ARD
- Liver disease (elevated liver enzymes)
- Upper quadrant pain, epigastric pain
- Proteinuria in blood
- Low platelet counts
At what point during pregnancy can preeclampsia be diagnosed?
Preeclampsia occurs at greater than 20 weeks gestation
- As trophoblast invasion into decidua is restricted
Current definitions of hypertensive disorders in pregnancy: chronic HTN
BP 140/90
- Prior to 20 weeks gestation and prior to conception or 20 weeks
Current definitions of hypertensive disorders in pregnancy: gestational HTN
New onset BP >140/90 at or beyond 20 weeks without signs of preeclampsia
Current definitions of hypertensive disorders in pregnancy: preeclampsia
Now applies to more people because diagnosing criteria no longer requires proteinuria
Current diagnostic criteria for preeclampsia
Systolic pressure >140 or diastolic >90 in two measurements taken 4+ hours apart
AND at lease one of the following:
- Proteinuria >300 mg in 24 hour urine
- Protein-creatinine ratio >0.3
- Spot urine >1 + proteinuria
- Platelet count <100,000
- Serum creatinine >1.1 mg/dL
- AST and ALT levels 2x more than normal
- Pulmonary edema
- Headache, visual disturbances
Severe HTN after __ weeks is equivalent to severe preeclampsia
20 weeks
What is considered severe BP? What should the provider do after getting a high reading?
>160 over >110 in a single episode
- Provider should NOT wait 4 hours to recheck and intervene
- BP should be repeated and patient treated
- Repeat and treat within 15 minutes
What is another hypertensive disorder that has liver involvement?
HELLP syndrome - severe form of preeclampsia
- Hemolysis
- Elevated liver function tests
- Low platelet count
