Hypertension in Pregnancy Flashcards
(55 cards)
What is chronic HTN?
HTN present before pregnancy or before 20th weeks or persists beyond 12 weeks post-partum
What is mild HTN?
140-159 / 90-109
What is gestational HTN?
Develops after the 20th week of pregnancy in the absence of proteinuria and resolves after delivery
What is severe HTN?
> 160/ >110
What is HTN with proteinuria after the 20th weeks of pregnancy?
Preeclampsia (“toxemia”)
What is the additional presence of seizures in a woman w/ pre-eclampsia w/ out hx of neurologic disease?
Eclampsia
what is HELLP Syndrome?
Presence of hemolysis, elevated liver enzymes, low platelet count
What is the predominant pathophys finding in preeclampsia and gestational HTN?
Maternal vasospasm
What happens to the renal system with HTN in pregnancy?
decrease GFR and proteinuria
decreased uric acid filtration
oliguria
What can happen with the fetus with maternal HTN?
Decreased placental perfusion
oligohydramnios (too little amniotic fluid)
IUGR
fetal hypoxia & malnutrition
What will patients with preeclampsia complain about?
Visual disturbance (scotomata) headache RUQ/ epigastric pain Peripheral edema rapid weight gain oliguria SOB
What will a patient with preeclampsia look like?
Puffy faced
edematous
tenderness over liver
hyper-reflexia
What labs do you want with precclampsia?
CBC, LFT
urinalysis (>0.3 grams protein in 24h specimen)
liver enzymes (elevated)
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
In severe preeclampsia what will the proteinuria be?
3+ or more than x2 on dipstick
What are some risk factors for preeclampsia?
DM chronic HTN or prior preeclampsia >35 years old African American obesity autoimmune dz pre-gestational DM
When do most cases of eclampsia occur?
within 24 hours of delivery but may occur 2-10 days AFTER
what is the criteria for HELLP syndrome?
Microangiopathic hemolysis, thrombocytopenia, hepatocellular dysfunction
When do you give meds to treat HTN in pregnancy?
Give meds when systolic is 150-160 or diastolic 100-110.
Can ACE inhibitors and ARB’s be given to pregnant women?
No due to fetal malformations
What is the treatment for mild preeclampsia?
Rest, frequent monitoring, deliver in timely manner
How do you treat severe precclampsia?
hospitalization
daily lab tests/ fetal surveillance
Give magnesium sulfate (prevent seizure)
give antihypertensive treatment
How do you manage an ecclamptic seizure?
make sure they don’t injure themselves
give magnesium sulfate to prevent further seizures
delivery once stable
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)
