Hypertension in Pregnancy Flashcards Preview

ObGyn Lecture > Hypertension in Pregnancy > Flashcards

Flashcards in Hypertension in Pregnancy Deck (55):
1

What is chronic HTN?

HTN present before pregnancy or before 20th weeks or persists beyond 12 weeks post-partum

2

What is mild HTN?

140-159 / 90-109

3

What is gestational HTN?

Develops after the 20th week of pregnancy in the absence of proteinuria and resolves after delivery

4

What is severe HTN?

>160/ >110

5

What is HTN with proteinuria after the 20th weeks of pregnancy?

Preeclampsia ("toxemia")

6

What is the additional presence of seizures in a woman w/ pre-eclampsia w/ out hx of neurologic disease?

Eclampsia

7

what is HELLP Syndrome?

Presence of hemolysis, elevated liver enzymes, low platelet count

8

What is the predominant pathophys finding in preeclampsia and gestational HTN?

Maternal vasospasm

9

What happens to the renal system with HTN in pregnancy?

decrease GFR and proteinuria
decreased uric acid filtration
oliguria

10

What can happen with the fetus with maternal HTN?

Decreased placental perfusion
oligohydramnios (too little amniotic fluid)
IUGR
fetal hypoxia & malnutrition

11

What will patients with preeclampsia complain about?

Visual disturbance (scotomata)
headache
RUQ/ epigastric pain
Peripheral edema
rapid weight gain
oliguria
SOB

12

What will a patient with preeclampsia look like?

Puffy faced
edematous
tenderness over liver
hyper-reflexia

13

What labs do you want with precclampsia?

CBC, LFT
urinalysis (>0.3 grams protein in 24h specimen)
liver enzymes (elevated)

14

After taking a BP sitting up, what way should you take the BP in a pregnant women.

Lay in left lateral position, can decrease BP

15

In severe preeclampsia what will the proteinuria be?

3+ or more than x2 on dipstick

16

What are some risk factors for preeclampsia?

DM
chronic HTN or prior preeclampsia
>35 years old
African American
obesity
autoimmune dz
pre-gestational DM

17

When do most cases of eclampsia occur?

within 24 hours of delivery but may occur 2-10 days AFTER

18

what is the criteria for HELLP syndrome?

Microangiopathic hemolysis, thrombocytopenia, hepatocellular dysfunction

19

When do you give meds to treat HTN in pregnancy?

Give meds when systolic is 150-160 or diastolic 100-110.

20

Can ACE inhibitors and ARB's be given to pregnant women?

No due to fetal malformations

21

What is the treatment for mild preeclampsia?

Rest, frequent monitoring, deliver in timely manner

22

How do you treat severe precclampsia?

hospitalization
daily lab tests/ fetal surveillance
Give magnesium sulfate (prevent seizure)
give antihypertensive treatment

23

How do you manage an ecclamptic seizure?

make sure they don't injure themselves
give magnesium sulfate to prevent further seizures
delivery once stable

24

What are some symptoms of HELLP syndrome?

vague, but N/V and viral-like
require cardiac stabilization and delivery
may need platelet transfusion (below 20,000)

25

What is where the placenta partially or completely covers the cervical os?

Placenta previa

26

What is a partial placenta previa?

Overlies the internal os. Often resolves by weeks 32-35

27

What is a complete placenta previa?

Covers the entire internal os.
Rarely resolves spontaneous

28

What is a "low-lying" placenta previa?

extends into lower uterine segment but doesn't reach internal os. Usually reviews by 32-35 weeks.

29

What is the clinical feature of placenta previa?

painless bleeding

30

Should you check the cervix at random?

No- must know where the placenta is first!

31

What are some risk factors for placenta previa

advanced age
smoking
cocaine use
high parity

32

How is a placenta previa baby be delivered?

Cesarean section

33

What is where placental tissue extends into the superficial layer of the myometrium?

Placenta accreta

34

What is where the placenta extends further into the myometrium?

Placenta increta

35

What is where the placenta extends completely through the myometrium to the serosa and sometimes to adjacent organs.

Placenta percreta

36

What is where there is a separation of a normally implanted placenta after the 20th week of gestation and before birth?

Placenta abruption

37

What is a complete placenta abruption?

entire placenta separates from teh uterine wall

38

What is a partial placental abruption?

Part of the placenta separates from the uterine wall

39

What is where the placenta separation is limited to the edge of the placenta?

Marginal abruption

40

What is where blood is trapped behind the placenta and is unable to exit?

concealed hemorrhage

41

what is the main clinical feature of placental abruption?

painful vaginal bleeding and tender uterus on palpation

42

What is where blood penetrates the uterus so that it turns the serosa blue or purple in color. This is a complication of placental abruption.

Couvelaire uterus

43

With an _____ in AFP, it is more likely to have placental abruption.

increase

44

What is the passage of fetal blood vessels over the internal os below the presenting part of the fetus?

Vasa previa

45

WHat is where there is spontaneous and complete transection of the uterus from the endometrium to the serosa?

Uterine rupture

46

What happens with uterine rupture?

Baby expelled into abdomen
immediate C-section needed

47

Who is at most risk for uterine rupture?

Those attempting to deliver vaginally after C-section

48

What is the most significant risk of pre term birth (PTB)?

a hx of preterm birth

49

What is a pre-term birth?

Occurs before 37 weeks

50

What is considered very PTB (pre-term birth)?

<32 weeks

51

How long is a normal cervix?

4 cm (gets shorter as you go into labor)

52

What SROM?

Spontaneous rupture of membranes
contracting then water breaks

53

What is PROM?

premature rupture of membranes
didn't start contracting and water breaks

54

What is PPROM?

Pre-term premature rupture of membranes
rupture of membranes before 37 weeks

55

How can you tell if there is amniotic fluid leakage (not just pee)?

See if it turns the alkaline paper blue
Have them cough and see if you see it (speculum exam)
get a sample of fluid onto slide and will see a fern pattern