Flashcards in Hypertensive disorders in pregnancy- Wootton Deck (22):
what is the definition of hypertension in preggo
sustained blood pressure higher than 140/90
what is gestational HTN?
recognized after 20 weks gestation, without proteinuria, resolves 12 weeks post partum
what do you do to asses the fetus of a mother with chronic hypertension?
must asses for well being- initial ultrsound to date accuratly, get growth ultrasounds monthly after 28 weeks gestation
what is mild HTN? and how do you manage?
less than 160/100
delivery at 39-40 weeks
what is the first line for anti HTN drugs in preggos?
methyldopa, can also use nifedipine, labetolol, hydralazine
what HTN medication is contrindicated in pregnancy?
what is the management of severe chronic HTN?
close monitoring, urine collection every trimester with renal disease, antepartum growth ultrasounds, delivery at 38 weeks, or with fetal lung maturity
what are teh major symptoms of pre eclampsia?
hypertension, proteinuria, (edema), headache
what are some risk factors for pre eclampsia?
age ( under 20 or over 35), multiple gestation, hydatitiform mole,
what are the findings in pre eclampsia?
cerebral edema, reduction in circulting blood volume, third spacing , non cardiogenic pulmonary edema ( changes in colloid osmotic pressure, can get liver rupture due to subscapular hematoma
what is the diagnopsis for severe pre eclampsia?
systolic BP over 160, diastolic over 110, on 2 occassions , 6 hours apart, 5 grams of protein in urine /24 hours, or 3+ protein on 2 random urine dips
does tylenol help the symptoms of pre eclampsia?
what are some findings on physical for pre eclampsia?
brisk refelexes, , clonus, increased hematocrit, LDH, AST/ALT, uric acid
what are the measures to manage severe pre eclampsia?
immediate hospitalization, if greater than 34 weeks, deliver, give antihypertensives ( hydralizine, labetelol) if less than 34 weeks, give steroids to help lung development to get the baby out
what is the prefered method of birthing?
vaginal delivery, can use pitocin ( cervical ripening) if needed, also give magnesium sulfate for siezure prophylaxis
when would a woman NOT be able to get an epidural?
when they have thrombocytopenia
what is eclampsia? how do you manage it?
siezure that lasts for 1-2 minutes, manage by diazepam, larazepam, Mg sulfate, dont get the baby out imediatly, allow the baby time to get back to normal in the uterus before you get it out
what is HELLP syndrome?
variant of pre eclmampsia, hemolysis, elevated liver enzymes, low platelets ,
will present with RUQ pain, can also have epigastric pain, and nausea/ vomitting
is there a proven traetment for HELLP?
NO- asprin and calcium are given now
woman has BP of 106/64 and 2+ pitting edema, no clonus, and normal reflexes, normal labs, whats teh Dx?
38 year old at 38 weeks presents and has BP 158/90 urine dip is 1+, this is a new finding, what would you do? if the patient later has hypersensitive relfexes, urine dip 2+ for protein, three beats of clonus, and low platlets, whats the DX?
recheck the BP and urine Dip-
DX for second part= HELLP syndrome