HTN in pregnancy (Wootton)

Question 1

Stage 1 HTN

Answer 1

systolic between 130-139 or diastolic between 80-89

Question 2

Stage 2 HTN

Answer 2

systolic above 140 or diastolic above 90

Question 3

Chronic HTN

Answer 3

present before or recognized during first half of pregnancy or persists after 12 weeks postpartum

Question 4

Gestational HTN

Answer 4

recognized after 20 weeks gestation WITHOUT any features of preeclampsia

Question 5

Preeclampsia

Answer 5

occurs after 20 weeks gestation and coexists with proteinuria

Question 6

Eclampsia

Answer 6

new onset seizure with preeclampsia

Question 7

Superimposed preeclampsia/eclampsia

Answer 7

transposed into chronic HTN

Question 8

How do you take an appropriate blood pressure?

Answer 8

patient rested for 10 mins; legs uncrossed; back supported; cuff length is 1.5 times the upper arm circumference (prob in obese patients)

Question 9

Management of mild HTN

Answer 9

BP less than 160/110; baby aspirin daily until delivery; prenatal visits every 2-4 weeks until 34 weeks, then weekly; delivery 38-39 weeks

Question 10

Management of severe chronic HTN

Answer 10

BP greater than 160/110; anti-HTN therapy - Labetalol to Nifedipine; close prenatal monitoring; 24 hour urine collection every trimester; delivery 37-39 weeks

**AVOID ACEi and ARBs - risk for fetal malformations

Question 11

Which hypertensive agents should be avoided in pregnancy?

Answer 11

ACEi and ARBs - risk for fetal malformations

Question 12

Diagnosis of preeclampsia

Answer 12

Triad: HTN, Proteinuria, Edema

Question 13

Rick factors for preeclampsia

Answer 13

<20 and >40, nulliparity and multifetal gestation; DM; obesity; chronic HTN; inter pregnancy interval >7 yrs; blacks

Question 14

What are the two types of preeclampsia?

Answer 14

1. Mild - preeclampsia w/o severe symptoms
2. Severe - preeclampsia w/ severe symptoms

Question 15

preeclampsia w/o severe symptoms

Answer 15

BP >140/90 but less than 160/110; proteinuria >300 mh/24hr OR urine protein:creatinine ratio 0.3mg/dL OR urine dipstick 2+

Question 16

preeclampsia w/ severe symptoms

Answer 16

BP >160/110 at least 2 times 4 hours apart; oliguria (less than 50 ml in 24 hours); elevated liver enzymes; pulmonary edema; and other symptoms

Question 17

management of preeclampsia w/o severe symptoms

Answer 17

less than 37 weeks - once BBP or twice NST weekly; fetal US every 3-4 weeks
more than 37 weeks - begin induction; if favorable then cervical induction, if not cervical ripening agent

Question 18

management of preeclampsia w/ severe symptoms

Answer 18

immediate hospitalization; deliver if greater than 34 weeks; anti-HTN meds; magnesium sulfate; less than 37 weeks give corticosteroids

Question 19

Therapy for seizure prophylaxis

Answer 19

magnesium sulfate

Question 20

magnesium sulfate

Answer 20

patients with preeclampsia w/ severe features for seizure prophylaxis; monitor urine output and reflexes

Question 21

What is the first thing to do in an eclamptic patient?

Answer 21

protect the airway

Question 22

What is the first line treatment in an eclamptic patient?

Answer 22

magnesium sulfate; may need lorazepam if seizures are persistent

Question 23

HELLP syndrome

Answer 23

variant of preeclampsia;
H = Hemolysis
EL = Elevated Liver enzymes
LP = Low Platelets