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Flashcards in HDP Deck (18):
1

List five maternal and three fetal complications of the hypertensive disorders of pregnancy.

Maternal: stroke, pulmonary edema, liver failure, seizure, placental abruption, acute renal failure
Fetal: oligohydramnios, IUGR, metabolic acidosis, fetal death

2

Which is the better predictor of adverse pregnancy outcome: systolic or diastolic blood pressure?

Diastolic blood pressure

3

Define HTN & severe HTN.

HTN: sBP > 140 or dBP > 90 on at least two measurements at least fifteen minutes apart in the same arm
(If measurements are different between the two arms, use the higher number)

Severe HTN: sBP > 160 or dBP > 110 (same stipulations as above)

4

What is the value of repeating definitive testing for proteinuria (24 hour urine protein collection or urinary protein:creatinine) in a patient who has been confirmed to have significant proteinuria?

No value.

5

How is super-imposed preeclampsia diagnosed in a patient with pre-gestational hypertension?

One or more of the following after 20 weeks' gestation:
- Resistant HTN (rise in BP or need for 3+ antihypertensives)
- New or worse proteinuria
- One or more adverse condition
- One or more severe complication

6

List three factors which lower the maternal threshold for preeclampsia.

- Metabolic syndrome
- Chronic infection or inflammation
- Pre-existing hypertension
- Chronic kidney disease
- DM
- High altitude

7

Describe the two models by which preeclampsia may arise.

Early onset/placental preeclampsia: imperfect placentation (immunological factors, interaction between decidua & trophoblast)

Late onset/maternal preeclampsia: lowered maternal threshold or excessive physiologic placentation (chronic disease, high altitude)

Both may coexist!

8

For each organ system, list one possible adverse condition & one possible severe complication of preeclampsia:
CNS
Cardio-respiratory
Hematologic
Renal
Hepatic

CNS:
- HA, visual symptoms
- eclampsia, PRES, cortical blindness, stroke, GCS < 13
Cardio-respiratory:
- CP, dyspnea, sat < 97%
- uncontrolled HTN, pulmonary edema, need for inotropes, MI
Heme:
- elevated WBC, decreased platelets, elevated INR/PTT
- platelets < 50, need for transfusion of any blood product
Renal:
- elevated creatinine, elevated uric acid
- AKI, need for dialysis
Hepatic:
- N & V, RUQ or epigastric pain, elevated liver enzymes or bilirubin, hypoalbuminemia
- INR > 2 without DIC, hepatic hematoma or rupture

9

List five tests that should be performed early in pregnancy for women with pre-existing hypertension (to stratify risk & establish baseline).

Creatinine
Potassium
Fasting blood glucose
Urinalysis
EKG

10

What two medications may reduce the incidence of preeclampsia in low-risk women? When should they be initiated? What additional intervention may reduce risk?

Calcium 1 g/day in women w/ low dietary intake - start before 16 weeks (when most transformation of the uterine spiral arteries occurs)

Folate - start prior to conception

Exercise

11

True or False:
- Antihypertensive treatment reduces risk of eclampsia
- Antihypertensive treatment reduces risk of adverse fetal and neonatal outcomes
- Antihypertensive treatment reduces risk of CVA

False
False
True

12

Which beta blocker is not recommended in pregnancy, and why?

Atenolol - associated with IUGR, maternal hypotension, maternal bradycardia

13

By what gestational age should you deliver women with uncomplicated pre-gestational hypertension?

38-39 weeks

14

For women with any HDP, what is the target intrapartum blood pressure?

< 160/110

15

You need to give magnesium sulfate for seizure prophylaxis, but cannot get IV access. What is the alternate dose & route?

MgS04 10 g IM (5 in each buttock) loading dose, then 5 g IM q4h

16

List three possible side effects of MgS04.

Weakness
Paralysis
Cardiac toxicity
Loss of patellar reflexes
Respiratory depression

17

How do you treat magnesium toxicity?

Give 10 mL calcium gluconate IV (push over 3 minutes)

18

List three reasons to avoid NSAID use postpartum in women with HDP.

HTN is difficult to control postpartum
Oliguria or AKI (creatinine > 90)
Platelets < 50