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Ob/gyn🤰👩🏼‍🍼 > HTN In Pregnancy > Flashcards

HTN In Pregnancy Flashcards

1
Q

Why it’s important to study about the HTN during pregnancy ?

A

Because it’s an a leading cause of maternal/fetal ad neonatal morbidity and mortality ….

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2
Q

Hemodynamic changes in normal pregnancy ?

A

1-Decrease the systemic vascular resistance ( due to progesterone )
2-cardiac output and plasma volume increase
3- physiological drop in the blood pressure before the first trimester due to vasodilation

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3
Q

The physiological drop in the blood pressure due to vasodilation happened in which trimester ?

A

End of first trimester

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4
Q

Definition of hypertension in pregnancy according to the American heart association

A

When the systolic is more than140 and diastolic is more than 90 on 2 occasions 4 hours apart

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5
Q

What is the definition of proteinuria according to the AHA ?

A

Presence of more than 300 mg of proteins in a 24 hours collection …

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6
Q

In pregnancy proteinuria the ratio between protein to creatinine is ?

A

More than 30 mg

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7
Q

We have 3 scenarios for a pregnant woman with hypertension ?

A

1- Diagnosed during the first 20 weeks or before pregnancy —-chronic hypertension/white coat

2- diagnosed after 20 weeks of pregnancy but without proteinuria or end organ damage -gestational

3- diagnosed after 20 weeks of gestation but with proteinuria and organ damage - preeclampsia

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8
Q

What is preeclampsia ?

A

Multi system syndrome developed after 20 weeks of gestation characterized by proteinuria ,end organ damage with hypertension

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9
Q

criteria of chronic hypertension ?

A

-diagnosed prior to 20 weeks of gestation
-persist for more than 12 weeks after pregnancy
- it’s more than 140/90 in mild hypertension
-more than 160/110 on the sever hypertension

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10
Q

The chronic hypertension is classified into 2 types ?

A

Primary (idiopathic)
Secondary due to -endocrine causes -cardiological & vascular causes
-renal causes

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11
Q

What are the renal causes that could lead to secondary chronic hypertension ?

A

-Polycystic kidney disease
-Glomerulonephritis
-Renal artery stenosis

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12
Q

Endocrine causes that leads to secondary chronic hypertension ?

A

Crushing syndrome
Conn’s syndrome

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13
Q

Cardiovascular causes that lead to secondary chronic hypertension ?

A

Coarctation of the aorta

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14
Q

HTN effects on the baby ?

A

Fetal growth restriction
Preterm birth
Perinatal mortality

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15
Q

Maternal Effects of hypertension ?

A

-preeclampsia (50%)
- placental abruption
- dic
-Death
-Over failure
-renal failure

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16
Q

What’s the effect of HTN on the mood of delivery?

A

It increase the risk of cesarean sections

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17
Q

Gestational hypertension is ?

A

Hypertension that is diagnosed after 20 weeks of pregnancy with no proteinuria or end organ damage .
It’s usually more than 10/90 2 readings 4 hours apart

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18
Q

What are the findings of maternal organ dysfunction in preeclampsia with the absence of proteinuria ?

A

Headache
Blurred vision
Epigastric pain
High liver enzymes

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19
Q

What is the early preeclampsia ? And what s the risk factors for it ?

A

When we have proteinuria and end organ failure before 20 weeks of gestation
-multiple gestation
-partial molar pregnancy

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20
Q

What is preeclampsia on a top of chronic hypertension ?

A

When we have history of hypertension before pregnancy but we have a history of complication (prouteinuria and maternal organ damage after 20 weeks of pregnancy

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21
Q

What are the maternal organ dysfunction of sever preeclampsia ?

A

Renal insufficiency
Hepatic dysfunction
Hematological complication (dic )
Pulmonary edema
Neurological complication (stoke ,sever headache ,hyperreflexia ,blindness )

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22
Q

What is the type of headache in preeclampsia patients ?

A

Occipital with hyperreflexia and increase risk of visual scotomata

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23
Q

What are the Investigations that should be done for the sever preeclampsia patients?

A

Blood pressure -160/110
LFT
Serum creatinine
Platelet count

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24
Q

Fetal investigation that should be done for a patient with severe preeclampsia?

A

CTG
US

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25
Q

The incidence of preeclampsia?

A

2-5% more in black women

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26
Q

What are he outcomes for preeclampsia when it comes to the time of delivery

A

1/3 -preterm preeclampsia
2/3 term preeclampsia

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27
Q

What are the maternal short term complication of preeclampsia?

A

1– eclampsia
2- blindness
3- liver failure
4-renal failure
5-pulmanory edema
6- death
7- DIC
8- HELP SYNDROME

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28
Q

What is the help enzyme ?

A

It’s a maternal complication for preeclampsia when the mother has
-hemolysis
-elevated liver enzyme
-low platelets

29
Q

What is eclampsia?

A

It’s a maternal complication of the sever pre eclampsia when the mother have convulsion and coma .

30
Q

What are he long term complication off preeclampsia?

A

-increase risk of having
Stroke
Ischemia
Hypertension
Death due to CVD

31
Q

The impact of eclampsia on neonate ?

A

-Responsible for 25% of neonatal death
-responsible for 15% of neonate growth restriction
-prematurity

32
Q

What is the mechanism by which the preeclampsia lead to complication for the neonate ?

A

1- reduce blood supply to placenta
2- decrease oxygen to the fetuse
3- that lead to premature delivery
4- risk of premature delivery such as ; death /brain seizure /respiratory difficulties

33
Q

The long time risk on a baby that has been exposed to preeclampsia before birth ?

A

Risk for DM
Risk for cerebral palsy
Risk for high blood pressure
Increase risk forCVD

34
Q

Why the risk for cerebral palsy is 2 more times higher in children who has been exposed to preeclampsia ?

A

Due to premature labor
Due to growth restriction

35
Q

The preeclampsia can’t be reduced by. ?

A

Bed rest
Salt intake restriction
Vitamin intake restriction

36
Q

The rate of preeclampsia can be reduced by ?

A

Aspiring before week 16 of gestation
Statins
Calcium Supplements

37
Q

Aspirin is used to decrease the risk of preeclampsia in the high risk groups within these conditions?

A

-before week 16 of gestation
-it decrease the preterm preeclampsia
-dose depend on weight

38
Q

What are the risk factors for having preeclampsia ?

A

-chronic hypertension
- diabetes mellitus
-black race
-advance maternal age
-high weight /short women
-anti phospholipid syndrome
-IVF pregnancy
-family history of preeclampsia

39
Q

Personal previous history of preeclampsia lead to increase the risk of a current preeclampsia into ?

A

10 times more

40
Q

The personal history of a previous pregnancy without a preeclampsia decrease the risk of preeclampsia into ?

A
41
Q

The risk f preeclampsia decrease in ?

A

-Parous women with no previous preeclampsia

42
Q

Screening for preeclampsia has. 3 intervals ?

A

11-13
20-24
30-34

43
Q

The screening of preeclampsia should be combined by screening of ?

A

Mean arterial pressure
Uterine artery pressurs
Risk factor
Preeclampsia markers

44
Q

What are the markers that should be screened for preeclampsia?

A

PLGF
SFLT 1

45
Q

What is the effect of screening for preeclampsia?

A

Predict about 90% of early preeclampsia
75% of preterm
45% f term

46
Q

mean arterial pressure as a screening test for preeclampsia ?

A

-It’s more accurate than measuring the systolic and diastolic
- it defined as the average arterial pressure during a single cardiac cycle .
-

47
Q

The formula of mean arterial pressure screening?

A

2/3 diastolic blood pressure +1/3 systolic pressure .

48
Q

Uterine artery pulsatility index measurement as a screening for preeclampsia is measured by ?

A
  • transvaginal /trans abdominal sonography
49
Q

On sonography how dose the uterine artery pulsatility index occurs if its normal ?

A

Waveform
Good end diastolic flow

50
Q

On sonography how dose the uterine artery pulsatility index occurs if its on a risk for preeclampsia?

A

High resistance to flow
Low end diastolic flow
Early diastolic notch

51
Q

Notch in uterine artery pulsatility index indicates ,and what is the next step ?

A

High risk for preeclampsia
Give aspirin
Follow up blood pressure manegment

52
Q

Placental growth factor for preeclampsia screening ?

A

-We measure by amount of plGF I serum
-Peek should be at 26-30
- if it doesn’t rise that may indicate placental dysfunction.

53
Q

PLGF is a protein that’s involved in what? What is its level in women with high risk for preeclampsia?

A

It’s a protein that’s involved in placental angiogenesis (development of new blood vessel ) and it’s usually low in women with preeclampsia

54
Q

sFlt-1 as a screening marker for preeclampsia?

A

It’s an anti angiogenic factors that plays an important role in preeclampsia pathogenesis
- it induce proteinuria,hypertension and glomerular endotheliosis

55
Q

Pregnancy associated plasma protine -A-
PAPP -A as a screening test for preeclampsia ?

A

It’s protein that’s produced by the placenta for placenta growth and development .

56
Q

What is the causes for PAPP-a reduction and during which trimester the changes happens ?

A

The PAPP-a- decrease in women with high risk of preeclampsia
The PAPP-a- decrease in pregnancy with fetal trisomy
—————————-
Usually changes. Happens during the first trimester

57
Q

In addition of being a screening marker for preeclampsia SFLT1 and PLGF could be used as an early mark we for ?

A

Predict intrauterine fetal death

58
Q

Management for high risk preeclampsia groups after screening?

A

Follow up blood pressure measuring
Regular dipstick for proteinuria
Start aspirin 🫠

59
Q

Management for chronic hypertension include ?

A

-stop some drugs
-blood pressure monitoring
-start pregnancy friendly anti hypertension medication
-aspirin since week12
-at early birth is necessary offer magnesium sulfate

60
Q

What are the drugs that should be stoped during pregnancy ?

A

ACE - fetal renal damage
Arb -fetal renal failure /lung dysplasia
Diuretic

61
Q

Effect of ACE and ARBS on the fetus ?

A

Fetal hypotension - reduce flow to non viable organs-decrease renal blood flow -kidney ischemia -Anuria -oligohydramios -lung hypoplasia

62
Q

Blood pressure monitoring should be done every ?

A

One week -non stable
2-4 weeks -stable

63
Q

Types of hypertensive drugs that should be given pregnancy to control chronic hypertension?

A

Labetalol
Nifedipine
Methyldoba

64
Q

Why methyledopa is not used in emergent HTN ?

A

Because I takes 48 hours to work
Increase risk of depression
Dose 250 mg (3 times a day )

65
Q

When the women with chronic hypertension should start aspirin ?

A

On week 12

66
Q

Chronic hypertension early delivery management?

A

Antenatal corticosteroid
Magnesium sulfate

67
Q

Management of mild preeclampsia?

A

It’s a proteinuria with hyper tension
The delivery of the women with mild preeclampsia usually after 37 weeks

68
Q

Expectant management for women with mild preeclampsia ?

A

-inpatient monitoring to establish the severity
-lab follow up ;ceriatenine ,ast once a week
-antenatal corticosteroid
-assessment for fetal wellbeing weekly (us/afi)

69
Q

Use of hypertensive drugs for mild preeclampsia?

A

Doesn’t effect he corse of the disease (not recommended)

Ob/gyn🤰👩🏼‍🍼 (9 decks)

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