Hypertensive disorders in pregnancy Flashcards
(39 cards)
does BP usually go up or down during the 1st trimester? why?
down
- increased maternal blood volume
- decreased colloid oncotic pressure
when is the lowest maternal BP during pregnancy?
13-20 weeks
what are the four types of HTN during pregnancy?
- chronic
- gestational
- preeclampsia
- preeclampsia superimposed on chronic HTN
chronic HTN: definition
- BP 140/90 prior to or during first 20 weeks of pregnancy
- no proteinemia
- BP remains elevated over 12 weeks postpartum
what are the common obstetrical complications to severe chronic HTN?
- superimposed preeclampsia
- premature birth
- intrauterine growth restriction
- fetal demise
- placental abruption
what is the management for chronic HTN?
lifestyle modification
when do you start hypertensive medication for chronic HTN?
when BP is over 160/110 or
continue pre-pregnancy treatment if
- multiple medications were required pre-pregnancy
- evidence of preexisting end organ dysfunction
what are the signs of preeclampsia?
- development of proteinuria
- sudden increase in BP when previously well-controlled
definition: gestational HTN
- nonproteinuric HTN after 20 weeks gestation
provisional diagnosis including
- women who go on to develop preeclampsia
- women with previously undiagnosed chronic HTN
- women who do not develop preeclampsia and whose blood pressures normalize postpartum
mild (under 160/110) or severe (over 160/110)
what is the management for mild gestational HTN?
expectant management
what is the management for severe gestational HTN?
same as for severe preeclampsia
definition: preeclampsia
- new onset HTN and proteiuria after 20 weeks gestation in a previously normotensive woman
- BP over 140 systolic OR over 90 diastolic on 2 separate occasions at least 6 hours apart
definition: mild preeclampsia
- BP 140/90 on 2 separate occasions at least 6 hours apart AND proteinuria over 0.3 g in a 24 hour urine specimen
definition: severe preeclampsia
- systolic over 160 or diastolic over 110 on two occasions at least 4 hours apart while at bedrest
- thrombocytopenia
- impaired liver function
- progressive renal insufficiency
- pulmonary edema
- new onset cerebral or visual disturbances
preeclampsia can mimic what other diseases?
- flu
- gall bladder disease
- migraines
what are the pregnancy associated risk factors for preeclampsia?
- chromosome abnormalities
- hydatidiform mole
- hydrops fetalis
- multifetal pregnancy
- oocyte donation or donor insemination
- structural congenital abnormalities
what are the maternal specific risk factors for preeclampsia?
- age under 20, over 35
- African American
- family history of preeclampsia
- NULLIPARITY**
- preeclampsia in previous pregnancy
- stress
- medical conditions (obesity, thrombophilias, antiphospholipid Ab syndrome)
definition: eclampsia
appearance of seizures in a patient with preeclampsia
definition: HELLP syndrome
a variant of preeclampsia with:
- hemolysis
- elevated liver enzymes
- low platelet count
what are the lab findings for the hemolysis portion of HELLP syndrome?
- abnormal peripheral smear (burr cells, schistocytes, or other abnormal RBC forms)
- LDH over 600
- bilirubin over 1.2
what are the lab findings for the elevated liver enzymes portion of HELLP syndrome?
AST or ALT over 100 IU/L
what are the lab findings for the low platelets portion of HELLP syndrome?
under 100,000 / mm3
what is the ultimate cure for preeclampsia?
delivery
what are the two key management goals for preeclampsia?
- control HTN
- prevent seizures
