HTN Disorders in Pregnancy - Wootton Flashcards

1
Q

Mom’s risks associated w/ HTN in pregnancy

A
  • MI, Cardiac failure, CVA, renal failure, hepatic failure
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2
Q

Fetus’ risks associated w/ HTN in pregnancy

A
  • Growth restriction
  • Preterm birth
  • Placental abruption
  • Stillbirth
  • Neonatal death
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3
Q

How to manage mild chronic HTN (before pregnancy started)

A
  • Anti-HTN drugs
  • Prenatal visits
  • Fetal monitoring
  • Delivery 39-40 weeks
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4
Q

Gestational HTN - definition

Occurs when?

A

HTN w/o any features of preeclampsia

Before 20 weeks

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5
Q

Symptoms of preeclampsia (besides the big 3)

A
  • Scotoma
  • Blurred vision
  • Epigastric/RUQ pain
  • Headache
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6
Q

Anything that affects ____ can be a risk factor for HTN (including preeclampsia)

A

Vascularity

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7
Q

Preeclampsia –> RUQ pain

A

Subcapsular hematoma (can rarely lead to liver rupture)

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8
Q

Severe features in preeclampsia

A
  • BP > 160 (systolic) or 110 (diastolic)
  • Proteinuria > 5 gms/day or 3+
  • Oliguria
  • Symptomatic (cerebral, visual, pulmonary edema, epigastric/RUQ, etc.)
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9
Q

Preeclampsia – PE finding

Lab findings

A

Brisk reflexes/clonus

  • Increased Hct, LDH, AST/ALT, uric acid
  • Low platelets
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10
Q

***3 major BP meds in preeclampsia

If less than 34 weeks?

A
  • Hydralazine
  • Labetalol
  • Nifedipine

Steroids, work towards delivery if mom and baby are stable

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11
Q

Preferred mechanism of birth

A

Vaginal delivery

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12
Q

People that can’t get an epidural

A

Low platelets (could get hematoma on spinal cord)

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13
Q

27, first pregnancy at 32 weeks, bilateral LE edema. Normal reflexes. Labs normal.

A

Normal - physiologic edema of pregnancy

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14
Q

39, AA, 38 wks. BP high (new). 1+ proteinuria…Next step in evaluation?

BP still high, urine dip 2+, +3/4 reflexes w/ beats of clonus. Slightly high creatinine, low platelets, liver enzymes 2x normal. Dx?

Do what now?

A

Send to L&D – do lab studies

HELLP syndrome

Induce delivery (w/ steroids)

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15
Q

21, 28 wks, headache unrelieved by Tylenol. Vision is a little blurred. No epigastric pain or N/V. Urinalysis = 5 gms protein in 24 hrs. High BP despite bed rest. Severely growth restricted infant.

Dx?
Next steps?

After traditional treatment modalities, BP still horrible. Next step?

A

Preeclampsia w/ severe features

Steroids (b/c pre-term), MgSO4, then work towards delivery

Antihypertensives (Hydralazine, Labetalol, Nifedipine)

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