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OB > HYPERTENSIVE DISORDERS > Flashcards

HYPERTENSIVE DISORDERS Flashcards

1
Q

Deadly Triad

A

Hypertensive Disorders
Hemorrhage
Infection

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2
Q

4 Types of Hypertensive Disease

A

Gestational HPN
Preeclampsia and Eclampsia Syndrome
Chronic HPN (any etiology)
Preeclampsia Superimposed on Chronic HPN

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3
Q

BP > 140/90 AFTER 20 weeks in previously NORMOTENSIVE women

A

GESTATIONAL HPN

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4
Q

Pregnancy specific syndrome that can affect virtually every organ system

A

PROTEINURIA
> 300 mg/24 h (macroalbuminuria) OR
urine protein:creatinine ratio > 0.3 OR
dipstick 1+ persistent

EVIDENCE IF MULTIORGAN INVOLVEMENT
thrombocytopenia (< 100 000/ul)
renal insufficiency (crea > 1.1 mg/dL or 2x)
liver involvement (AST or ALT 2x)
cerebral symptoms - headache, visual disturbances, convulsions
pulmonary edema

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5
Q

Convulsion that cannot be attributed to another cause in a women with preeclampsia

generalized seizure

A

ECLAMPSIA

MC at 3rd trimester

1st trimester - ass with molar or hydropic degeneration of placenta

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6
Q

Complications of Eclampsia

A 
abruptio placenta
neurologic deficits
aspiration pneumonia
pulmonary edema
cardiorespiratory arrest
acute renal failure
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7
Q

BP 140/90 BEFORE pregnancy or diagnosed BEFORE 20 weeks gestations not attributable to gestational trophoblastic disease

OR

HPN persistent AFTER 12 weeks postpartum

A

Chronic HPN

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8
Q

Gestational HPN disorders are more likely to develop in women who

A

exposed to chorionic villi for the first time
exposed to superabundance of chorionic villi (twins or H. mole)
preexisting renal or cardiovascular disease
genetically predisposed to HPN developing during pregnancy

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9
Q

Preeclampsia 2 stage disorder

A

STAGE I - preclinical
faulty trophoblastic vascular remodelling of uterine straight arteries –> placental hypoxia

STAGE II - caused by release of placental factors into the maternal circulation –> systemic inflammatory response and endothelial activation

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10
Q

Pre existing chronic HPN woth NEW ONSET proteinuria and signs/symptoms of various end organ dysfunction

A

Chronic HPN with Superimposed Preeclampsia

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11
Q

Prevention of Preeclampsia syndrome

A

High dose calcium

Low dose aspirin

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12
Q

Contraindications to Conservative Management in Severe Preeclampsia

A

persistent symptoms or severe HPN
eclampsia, pulmonary edema, HELLP syndrome
significant renal dysfunction, coagulopathy
abruption
previable fetus
fetal compromise

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13
Q

Measures the hypertensive response in women at 28-32 weeks AOG who are resting in the L lateral decubitus position and then roll over to assume a supine position

from L lateral decubitus get BP, 5 mins supine position then get BP again

A

Roll Over Test

(+) role test - increased in 20 mmHg in the diastolic pressure

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14
Q

Done at 24 weeks AOG

increase uterine artery resistance in the 1st or middle trimester

A

Uterine Artery Doppler Velocimetry

(+) diastolic notch - predictive test for preeclampsia

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15
Q

Earliest laboratory manifestation of preeclampsia

A

HYPERURICEMIA

d.t. decreased uric acid clearance from decreased glomerular filtration

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16
Q

HELLP syndrome

A

hemoglobunuria
hyperbilirubinemia
increased LDH, AST, ALT
thrombocytopenia

17
Q

Methods to Prevent Preeclampsia

A

Dietary manipulation - low salt diet, calcium or fish oil supplementation

Exercise - physical activity, stretching

Cardiovascular drugs - diuretics, antihypertensive drugs

Antioxidants - ascorbic acid (vitamin C), alpha tocopherol (vitamin E), vitamin D

Antithrombotic drugs - low dose aspirin, aspirin/dipyridamole, aspirin + heparin, aspirin + ketanserin

18
Q

Diagnosis of HELLP syndrome

A

HEMOLYTIC ANEMIA
schistocytes on PBS
elevated LDH
elevated total bilirubin

ELEVATED LIVER ENZYMES
increase in AST
increase in ALT

LOW PLATELETS
thrombocytopenia

19
Q

Urgent control of SEVERE HPN in pregnancy

A

Labetalol - avoid in women with asthma or CHF

Hyralazine - DOC

Nifedipine - caution with MgSO4

Nicardipine IV - caution with MgSO4

20
Q

Treatment for Gestational or Chronic HPN in pregnancy

A

Methyldopa - 1st line DOC

Labetalol - causes fetal growth restriction

Nifedipine - (-) labor

Hydralazine - causes neonatal thrombocytopenia

B-blocker - decrease uteroplacental blood flow; impair fetal response to hypoxic stress

Hydrochlorothiazide - cause volume contraction and electroyte disorders
useful in combi with methyldopa and vasodilator

21
Q

DOC for prevention of convulsions

A

Magnesium sulfate (MgSO4)

loading dose of 4 g/slow IV over 5-10 mins and 5 g/deep IM on each buttock then 5 g/IM

loading dose of 4g/slow IV then IV infusion of 2g/hr as ff
*D5w 1 L + 20 MgSO4 (10 ml ampules of 50% MgSO4 x 4) to run at 100 ml/hr (2g/hr) via infusion pump or soluset

22
Q

Magnesium Sulfate Precautions

A

U/O of at least 30 mL/hr or 100 mL for 4 hrs

(+) patellar reflex

RR of NOT < 12/minute

CALCIUM GLUCONATE

23
Q

Serum MgSO4 Levels

A

4-7 mEq/L (4.8 to 8.4. mg/dL ) - PREVENTS CONVULSION

8 -10 mEq/L - (-) patellar reflex

12 mEq/L - prolonged AV conduction

12-15 mEq/L - respiratory depression

24 mEq/L - cardiac arrest

24
Q

Other Anti-Seizure Drugs

A

Diazepam

Phenytoin

25
Q

MOA of Magnesium Sulfate

A

decreased presynaptic release of the neurotransmitter glutamate

blockade of glutamatergic N methyl D aspartate

potentiation of adenosine action

26
Q

Aneurysms in the deep penetrating arteries of the LENTICULOSTRIATE branch of the MCA d.t. long standing HPN

A

Charcot Bouchard Aneurysms

27
Q

Long term Consequences in Women with Preeclampsia Syndrome

A 
CARDIO
chronic HPN
IHD
atherosclerosis
coronary artery calcification
cardiomyopathy
thromboembolism

NEUROVASCULAR
stroke
retinal detachment
diabetic retinopathy

METABOLIC
type 2 diabetes
metabolic syndrome
dyslipidemia
obesity

RENAL
glomerular dysfunction
proteinuria

CNS
white matter lesions
cognitive dysfunction
retinopathy

OB (16 decks)

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