Hypertensive Disorders In Pregnancy Flashcards
(49 cards)
Hypertensive disorders complicates …% of pregnancy
complicate 5 to 10 percent of all pregnancies
What is the risk of PET in patient with 1st relative with hx of pre-eclampsia.
3x
What is the risk of Preeclampsia in patient with previous history of pre-eclampsia.
7x
What is the efficacy of using aspirin in PET prevention ?
10-20 % reduction.
evidence of efficacy
Proteinuria
+1 equal to ….. ?
+2
+3
less than 150 mg/24 hours (upper limit of normal)
1+ = 200 - 500 mg/24 hours.
2+ = 500 - 1500 mg/24 hours.
3+ = over 2500 mg/24 hours
4+ = over 3000 mg/24 hours
Proteinuria in preeclampsia is not required if any of the following new-onset findings present:
- Platelet <100000
- creatinine > 1.1mg/dl or doubled from baseline
- transaminases twice the normal.
- pulmonary Edema
- cerebral or visual symptoms
- blood pressure >160/110
Management of preeclampsia without severe features ?
Antepartum surveillance as outpatient: NST, AF measurements, BPP, growth USS Q 3-4 wks.
Weekly: CBC, transaminases(No need to Follow urine protein, as even > 5 g is not considered a severe feature.
Mangament of preeclampsia with severe features:
- maternal evaluation:
-symptoms assessment Q 8hrs: HE, visual changes, RUQ or epigastric or retrosternal pain or pressure. - v/s Q 15-60 min
- monitor I/O, insert Foley’s when needed( notify for < 30 ml urine per hour)
- Labs daily: CBC, …
- MgSo4 (seizure prophylactic and decrease risk of Abruptio placenta NNT=100)
what is important to consult patient developed Preeclampsia Syndrome for future?
it heralds a higher incidence of cardiovascular disease later in life
The proportion that develops seizures later, after 48 hours postpartum, approximates __ percent
The proportion that develops seizures later, after 48 hours postpartum, approximates 10 percent
remember that
Headaches or visual disturbances such as scotomata can precede eclampsia
epigastric or right upper quadrant pain in preeclampsia due to
accompanies hepatocellular necrosis, ischemia, and edema that ostensibly stretches Glisson capsule.
the incidence of preeclampsia in nulliparous populations ranged from –to– percent. The incidence of preeclampsia in multiparas also varies and ranges
from – to – percent
the incidence of preeclampsia in nulliparous populations ranged from 3 to 10 percent. The incidence of preeclampsia in multiparas also varies and ranges from 1.4 to 4 percent
Defective placentation is posited to further cause the susceptible woman to develop
gestational hypertension, the preeclampsia syndrome, preterm delivery, a growthrestricted fetus, and/or placental abruption.
Women with a trisomy 13 fetus also have a – to –percent incidence of preeclampsia
Women with a trisomy 13 fetus also have a 30- to 40-percent incidence of preeclampsia
incident risk for preeclampsia of – to – percent for daughters of preeclamptic mothers; – to – percent for sisters of preeclamptic women; and – to – percent for twins..
n incident risk for preeclampsia of 20 to 40 percent for daughters of preeclamptic mothers; 11 to 37 percent for sisters of preeclamptic women; and 22 to 47 percent for twins.
Cardiovascular disturbances are common with preeclampsia syndrome. These are related to:
(1) greater cardiac afterload caused by hypertension; (2) reduced cardiac preload by a pathologically diminished volume expansion during
pregnancy
(3) endothelial activation leading to interendothelial extravasation of intravascular fluid into the extracellular space and, importantly, into the lungs.
Of women with preeclampsia, serial echocardiographic studies document diastolic dysfunction in 40 to 45 percent
when combined with underlying ventricular dysfunction—for example, concentric ventricular
hypertrophy from chronic hypertension—further diastolic dysfunction may cause cardiogenic pulmonary edema !
Abnormally low platelets do not develop in the fetuses or neonates born to preeclamptic women despite severe maternal thrombocytopenia. Thus,
maternal thrombocytopenia in a hypertensive woman is not a fetal indication for cesarean delivery.
Severe preeclampsia is frequently accompanied by hemolysis, which manifests as
elevated serum lactate dehydrogenase levels and reduced haptoglobin levels. Other evidence comes from schizocytosis, spherocytosis, and reticulocytosis in peripheral blood
In most cases of PET induced-thromocytopenia, delivery is advisable because worsening thrombocytopenia usually ensues. After delivery, the platelet count may continue to decline for the first day or so. It then usually rises progressively to reach a normal level within 3 to 5 days.
in some instances with HELLP syndrome, the platelet count continues to fall after delivery. If these do not reach a nadir until 48 to 72 hours, then preeclampsia syndrome may be incorrectly attributed to one of the thrombotic microangiopathies
remember that
Intensive intravenous fluid therapy is not indicated as
“treatment” for preeclamptic women with oliguria unless urine output is diminished from hemorrhage or fluid loss from vomiting or fever.
10 to 15 percent of women with HELLP syndrome do not have proteinuria at presentation.
In one report, 17 percent of eclamptic women did not
have proteinuria by the time of seizures.
HELLP syndrome Complications included
eclampsia in 6 percent, placental abruption—10 percent, acute kidney injury—5 percent, and pulmonary edema—10 percent. Stroke, hepatic hematoma, coagulopathy, acute respiratory distress syndrome, and sepsis were other serious complications.
