hypertension in pregnancy

Question 1

what is hypertension defined as?

Answer 1

> /= 140/90 on at least 2 readings at least 4-6 hours apart

Question 2

what is the number one risk of maternal and fetal morbidity and mortality?

Answer 2

hypertension

Question 3

gestational htn and preeclampsia have a higher risk of what later in life?

Answer 3

heart disease

Question 4

what is a risk factor for future cardiovascular and metabolic disorders in mothers?

Answer 4

preeclampsia

Question 5

what are 5 high risk factors for preeclampsia?

Answer 5

1. chronic htn
2. ckd
3. htn in previous pregnancy
4. dm (1 and 2)
5. autoimmune diseases

Question 6

what are 5 moderate risk factors to preeclampsia?

Answer 6

1. age >40
2. first pregnancy
3. multi-gestational pregnancy
4. bmi >35
5. family history of preeclampsia

Question 7

what is the presentation of preeclampsia?

Answer 7

typically asymptomatic

Question 8

what are 2 standard screenings for preeclampsia?

Answer 8

1. BP screen
2. Urinalysis standard

Question 9

what are 5 “hidden” signs of preeclampsia?

Answer 9

1. headache
2. change in vision
3. rapid weight gain
4. edema
5. abdominal pain

Question 10

what is the only true cure of preeclampsia?

Answer 10

delivery

Question 11

what are the 2 diagnostic criteria of preeclampsia?

Answer 11

1. blood pressure
2. proteinuria

Question 12

what is diagnostic for proteinuria in preeclampsia?

Answer 12

> /= 300 mg per 24 hour urine collection

Question 13

what is not a diagnostic tool for proteinuria in preeclampsia?

Answer 13

dip stick reading of 1+

Question 14

when may delivery be indicated in a patient with preeclampsia?

Answer 14

if preeclampsia is uncontrolled for 24-48 hours

Question 15

what are 6 severe preeclampsia symptoms?

Answer 15

1. htn (>160 systolic, >110 diastolic)
2. thrombocytopenia
3. impaired liver function
4. renal insufficiency
5. pulmonary edema
6. visual disturbance

Question 16

what are 2 things that are used for prevention of preeclampsia?

Answer 16

1. aspirin or LMWH
2. calcium

Question 17

what are 4 non pharm treatments for htn and preeclampsia?

Answer 17

1. modified bed rest
2. sodium restriction
3. frequent fetal monitoring
4. daily bp monitoring

Question 18

when is treatment for htn recommended?

Answer 18

1. chronic htn with persistent readings over 160/105
2. severe htn with readings over 160/100 mmhg

Question 19

what are 3 medications that acn be used to treat the htn?

Answer 19

1. methyldopa
2. nifedipine
3. labetolol

Question 20

what drug used for htn is an alpha 2 agonist?

Answer 20

methyldopa

Question 21

what are the starting doses for nifedipine?

Answer 21

30-60 mg once or twice daily

Question 22

what drug used for htn is a alpha/beta blocker

Answer 22

labetolol

Question 23

what is the doc to treat the htn?

Answer 23

labetolol

Question 24

when should you avoid the use of labetolol?

Answer 24

in pts with copd and asthma

Question 25

what are 3 SE seen with nifedipine?

Answer 25

1. flushing 2. headache 3. edema

Question 26

what are 4 treatments that are not recommended?

Answer 26

1. hydralazine 2. ACEi/ARBs 3. metoprolol/atenolol 4. diuretics

Question 27

why is hydralazine not recommended?

Answer 27

fetal heart abnormailities

Question 28

why are ACEi/ARBs not recommended?

Answer 28

they are fetotoxic

Question 29

why are diuretics not recommended?

Answer 29

affects uterine blood flow

Question 30

why is metoprolol/atenolol not recommended?

Answer 30

risk of intrauterine growth restriction

Question 31

what is eclampsia?

Answer 31

preeclampsia with seizures

Question 32

when is eclampsia the most common?

Answer 32

in the 3rd trimester or within 48 hours of delivery

Question 33

what is used for eclampsia prophylaxis?

Answer 33

magnesium sulfate

Question 34

what are 4 ADRs that are seen with magnesium sulfate?

Answer 34

1. confusion 2. somnolence 3. respiratory depression 4. cardiac arrest

Question 35

what is considered a premature delivery?

Answer 35

birth prior to 36.6 weeks

Question 36

what is considered full term?

Answer 36

40 weeks or 37 if possible

Question 37

what are 2 treatments for premature prophylaxis?

Answer 37

1. betamethasone 2. dexamethasone

Question 38

when can you give premature prophylaxis?

Answer 38

gestational age 24-34 weeks and at risk of delivering within 7 days

Question 39

when is treatment for BP after delivery recommended?

Answer 39

>150/110 mmHg

Question 40

if hydralazine or thiazides were given prior to birth what should be done?

Answer 40

a CBC in neonate because of reported cases of thrombocytopenia