Mod VIII: Hypertensive Disorders during Pregnancy - Pre-eclampsia

Question 1

Definition of High-Risk Pregnancies

Answer 1

“High-risk obstetric patients include women with pre-existing medical problems as well as pregnant women experiencing complications of the pregnancy itself.”

Question 2

_{Anesthesia and the High Risk Parturient}

Physiologic abnormalities that make a parturient a “high risk parturient” include:

Answer 2

Cardiac disease

Pre-eclampsia/HTN

Obstetric hemorrhage

Abnormal fetal presentation

Multiple gestation

Preterm labor

DM

Morbid obesity

Question 3

_{Anesthesia and the High Risk Parturient}

Hypertensive Disorders during Pregnancy include:

Answer 3

Chronic HTN

^{Onset prior to 20th week gestation}

^{No resolution PP}

^{No proteinuria end-organ damage}

Gestational HTN

^{Onset after mid pregnancy to 24 hrs. PP}

^{Resolves within 10 days PP}

^{No proteinuria/end-organ damage}

Chronic HTN with superimposed Preeclampsia

^{Onset prior to 20th week gestation}

^{Sudden increase HTN during pregnancy}

^{Proteinuria present}

Preeclampsia (PIH)

^Mild

^Severe

^Eclampsia

Question 4

_{Hypertensive Disorders during Pregnancy - Chronic HTN}

When does Chronic hypertension start?

Answer 4

Chronic hypertension may precede pregnancy and

may or may not be complicated by superimposed preeclampsia

Onset is usually prior to 20th week gestation

Question 5

_{Hypertensive Disorders during Pregnancy - Chronic HTN}

T/F: Chronic hypertension resolves PP

Answer 5

False

No resolution PP

Question 6

_{Hypertensive Disorders during Pregnancy - Chronic HTN}

T/F: Chronic hypertension is associated with proteinuria end-organ damage

Answer 6

False

No proteinuria, No end-organ damage w/ chronic HTN

Question 7

_{Hypertensive Disorders during Pregnancy - Gestational HTN}

When is the onset of Gestational HTN? When does it resolve?

Answer 7

Onset after mid pregnancy to 24 hrs. PP

Resolves within 10 days PP (this is why it’s called gestational)

Question 8

_{Hypertensive Disorders during Pregnancy - Gestational HTN}

T/F: Gestational HTN is associated w/ proteinuria and end-organ damage

Answer 8

False

No proteinuria/end-organ damage

Question 9

_{Hypertensive Disorders during Pregnancy}

T/F: Proteinuria and End-organ damge are absent in both chronic HTN and Gestational HTN

Answer 9

True

Question 10

_{Hypertensive Disorders during Pregnancy - Chronic HTN with superimposed Preeclampsia}

When is the Onset of Chronic HTN with superimposed Preeclampsia? How does it manifest?

Answer 10

Onset prior to 20th week gestation

Manifest as Sudden increase HTN during pregnancy

Question 11

_{Hypertensive Disorders during Pregnancy - Chronic HTN with superimposed Preeclampsia}

T/F: Proteinuria is present in Chronic HTN with superimposed Preeclampsia

Answer 11

True

Proteinuria present

Question 12

_{Hypertensive Disorders during Pregnancy - Preeclampsia (PIH)}

What are the different forms of Preeclampsia aka [Pregnancy-Induced Hypertension (PIH)]?

Answer 12

Mild Preeclampsia

Severe Preeclampsia

_{Can evolve into Eclampsia}

Question 13

_{Hypertensive Disorders during Pregnancy}

Development of HTN and proteinuria after 20 weeks gestation resolving within 48 hrs after delivery is also known as:

Answer 13

Preeclampsia

Complicates 7% of all pregnancies

Major cause of maternal morbidity/mortality

20% of perinatal deaths

Multisystem disorder unique pregnancy

Question 14

_{Hypertensive Disorders during Pregnancy}

Why is Preeclampsia a multisystem disorder unique to pregnancy?

Answer 14

A placenta is required for Preeclampsia

Question 15

_{Mild Preeclampsia}

How are SBP & DBP values in Mild Preeclampsia?

Answer 15

Mild Preeclampsia

SBP ≥ 140 mmHg or ≥ 30 mmHg above baseline

or

DBP ≥ 90 mmHg or ≥ 15 mmHg above baseline

Question 16

_{Mild Preeclampsia}

How is Proteinuria w/ Mild Preeclampsia?

Answer 16

Proteinuria

UOP ≥ 500 mg/24hr

Urine protein < 5g/24hr

Urine protein ≥ 1+ dipstick

Question 17

_{Mild Preeclampsia}

T/F: Edema can be a physiologic or pathologic occurrence w/ Mild Preeclampsia, but should not be used in the diagnosis

Answer 17

True

Edema can be a physiologic or pathologic occurrence w/ Mild Preeclampsia, therefore should not be used in the diagnosis of Mild pre-eclampsia

Question 18

_{Mild Preeclampsia}

T/F: Evidence of other organ dysfunction is present in Mild Preeclampsia

Answer 18

False

Evidence of other organ dysfunction is NOT present in Mild Preeclampsia

Question 19

_{Hypertensive Disorders during Pregnancy}

T/F: Organ dysfunction is absent in Chronic HTN, Gestational HTN and Mild pre-eclampsia

Answer 19

True

Question 20

_{Severe Preeclampsia}

What physiologic changes accompany Severe Preeclampsia?

Answer 20

Hypertension

^{SBP ≥ 160 mmHg or DBP ≥ 110 mmHg}

Severe proteinuria

^{3-4+ dipstick / ≥ 5 gm/24hr}

Oliguria

^{< 400 ml/24hr}

Pulmonary edema

Thrombocytopenia

^{PLT < 150K}

Question 21

_{Severe Preeclampsia}

How are BP values w/ Severe Preeclampsia?

Answer 21

_{Severe Preeclampsia}

SBP ≥ 160 mmHg or DBP ≥ 110 mmHg

Question 22

_{Severe Preeclampsia}

How is proteinuria w/ Severe Preeclampsia?

Answer 22

Severe proteinuria

Urine protein ≥ 5 gm/24hr

Urine dipstick 3-4+

Question 23

_{Severe Preeclampsia}

What’s the characteristic of oliguria in Severe Preeclampsia

Answer 23

_{Severe Preeclampsia}

UOP < 400 ml/24hr

Question 24

_{Severe Preeclampsia}

What’s the characteristic of Thrombocytopenia in Severe Preeclampsia?

Answer 24

_{Severe Preeclampsia}

PLT < 150K

Question 25

_Preeclampsia Most of the significant morbidity and mortality related to Preeclampsia is found in which subset of the condition?

Answer 25

Severe Preeclampsia

Question 26

_{Severe Preeclampsia} To meet the diagnosis criteria of severe pre-eclampsia, the pt must

Answer 26

Meet the _mild pre-eclamptic criteria_ and one or more of the _Severe Preeclampsia_ criteria _{(Hypertension*, Severe proteinuria, Oliguria, Pulmonary edema, Thrombocytopenia)}

Question 27

_{Severe Preeclampsia} Under which conditions could BP elevation be included in the diagnosis of severe pre-eclampsia?

Answer 27

BP elevation should occur on _two occasions_ _6 or more hours apart_ in a pregnant woman on **bedrest** before it can be said that they are serverely pre-eclamptic

Question 28

_{Severe Preeclampsia} Organ system involvement in Severe Preeclampsia include:

Answer 28

**Hepatocellular dysfunction** ^{↑ Liver enzymes, Epigastric/RUQ pain} **HELLP Syndrome** ^{Hemolysis, Elevated Liver enzymes, Low PLT} **Cerebral edema with visual disturbances** ^{Headache, Blurred vision, LOC, Seizure (Eclampsia)}

Question 29

_{Severe Preeclampsia} Hepatocellular dysfunction in Severe Preeclampsia is a/w:

Answer 29

↑ Liver enzymes Epigastric/RUQ pain (usually d/t liver edema or subcapsular hematomas)

Question 30

_{Severe Preeclampsia} Epigastric/RUQ pain in Hepatocellular dysfunction due to Severe Preeclampsia is usually the result of:

Answer 30

Liver edema. or Subcapsular hematomas

Question 31

_{Severe Preeclampsia} Cerebral edema with visual disturbances in Severe Preeclampsia is a/w:

Answer 31

Headache Blurred vision LOC Seizure (Eclampsia)

Question 32

_{Severe Preeclampsia} HELLP Syndrome in Severe Preeclampsia is a/w:

Answer 32

Hemolysis Elevated Liver enzymes Low PLT

Question 33

_{Severe pre-eclampsia} Seizure is only present in which eclamptic subset?

Answer 33

**Eclampsia**

Question 34

_Preeclampsia Risk Factors of Preeclampsia:

Answer 34

Chronic HTN Family Hx Obesity Prior pre-eclampsia Nulliparity and young age ^{(never given birth or 1st pregnancy)} Advanced maternal age (\>40yo) African-Americans Multiple gestations DM Chronic Renal Failure

Question 35

Pathophysiology of Preeclampsia

Answer 35

**OBSCURE & COMPLEX!!!** _Uncertain etiology_ ^{Immunological - Genetic - Environmental} _Exact mechanism unclear_ ^{Abnormal prostaglandin metabolism - Endothelial dysfunction Vascular hyperactivity} _Presence of placental tissue is necessary_ **Systemic disorder**

Question 36

_{Pathophysiology of Preeclampsia} Possible etiologies of Preeclampsia include:

Answer 36

Immunological Genetic Environmental

Question 37

_{Pathophysiology of Preeclampsia} Possible Pathophysiologic mechanisms of Preeclampsia include:

Answer 37

Abnormal **prostaglandin metabolism** **Endothelial** dysfunction **Vascular hyperactivity**

Question 38

_{Pathophysiology of Preeclampsia} T/F: Presence of placental tissue is necessary for Preeclampsia and the condition is a/w Systemic disorder

Answer 38

**True**

Question 39

CNS Manifestations of Preeclampsia:

Answer 39

Headache Visual disturbances Hyperreflexia Focal hypoperfusion =\> Cerebral ischemia/infarction Seizures (Eclampsia) Edema Intracranial hemorrhage =\> Leading cause maternal death in preeclamptic parturient

Question 40

_{CNS Manifestations of Preeclampsia} What's the Leading cause maternal death in preeclamptic parturient?

Answer 40

**Intracranial hemorrhage**

Question 41

CV Manifestations of Preeclampsia

Answer 41

Systemic vasoconstriction ↑ vascular response to SNS stimulation LV hypertrophy → CHF & Pulmonary edema Hemodynamic changes variable!!!\*

Question 42

_{CV Manifestations of Preeclampsia} Changes in Hemodynamic variable include:

Answer 42

↑ SVR ↓ CVP PCWP can be unchanged or increased CO can be Hyperdynamic or low Most: Low C.O with normal filling pressures & ↑ SVR

Question 43

_{CV Manifestations of Preeclampsia} For the most part, how does Preeclampsia affect CO?

Answer 43

Lowers C.O with normal filling pressures & ↑ SVR

Question 44

_{CV Manifestations of Preeclampsia} What causes **Contracted vasculature** in Preeclampsia?

Answer 44

Fluid/protein shift from intravascular to interstitial (this is d/t ↓ colloid oncotic pressure/↑ capillary leakage)

Question 45

_{CV Manifestations of Preeclampsia} What are the net volume, hemoconcentration, and electrolyte changes caused by a contracted vasculature in Preeclampsia? What aggravates these effects?

Answer 45

Hypovolemia - Hypoproteinemia Hemoconcentration → ↑ blood viscosity Pulmonary edema (Non-cardiogenic vs. cardiogenic) **Aggravated by proteinuria!!!!**

Question 46

Hepatic Manifestations of Preeclampsia

Answer 46

Periportal necrosis ^{d/t ↓ blood supply to liver} Subscapular hemorrhage ^{evidenced by Epigastric/RUQ pain} Rupture of overstretched liver capsule ^{Leads to Massive hemorrhage into abdominal cavity} Elevated liver enzymes HELLP syndrome ^{Stands for Hemolytic, Elevated Liver enzymes, Low Platelets}

Question 47

_{Hepatic Manifestations of Preeclampsia} Decreased blood supply to liver in Preeclampsia could result in:

Answer 47

**Periportal necrosis**

Question 48

_{Hepatic Manifestations of Preeclampsia} The Epigastric/RUQ pain seen in Preeclampsia is often the result of:

Answer 48

**Subcaspular hemorrhage**

Question 49

_{Hepatic Manifestations of Preeclampsia} Massive hemorrhage into abdominal cavity in preeclampsia is often the result of:

Answer 49

Rupture of overstretched liver capsule

Question 50

_{Renal Manifestations of Preeclampsia:} How could swelling of glomerular endothelial cells and deposition of fibrin affect renal capillaries?

Answer 50

**Renal capillary constriction**

Question 51

_{Renal Manifestations of Preeclampsia:} What are the consequences of Renal capillary constriction from Swelling of glomerular endothelial cells and deposition of fibrin?

Answer 51

↓ Renal blood flow ↓ GFR Oliguria Proteinuria Na+ & H20 retention (edema) ↓ urea & creatinine clearance Acute tubular necrosis

Question 52

Pulmonary Manifestations of Preeclampsia:

Answer 52

**Upper airway narrowing from pharyngolaryngeal edema** ^{(Leading to Respiratory compromise and Difficult intubation)} **Pulmonary edema** ^{(D/t ↑ capillary permeability, ↓ colloid oncotic pressure, Heart failure and Circulatory overload)}

Question 53

_{Pulmonary Manifestations of Preeclampsia} What's responsible for Respiratory compromise and Difficult intubation a/w Preeclampsia?

Answer 53

_Upper airway narrowing_ from **Pharyngolaryngeal edema**

Question 54

_{Pulmonary Manifestations of Preeclampsia} What's responsible for Pulmonary edema a/w Preeclampsia?

Answer 54

↑ capillary permeability ↓ colloid oncotic pressure Heart failure Circulatory overload

Question 55

_{Pulmonary Manifestations of Preeclampsia} Upper airway narrowing from pharyngolaryngeal edema can cause:

Answer 55

Respiratory compromise Difficult intubation ^{(especially if the pt is already experiencing edema and swelling b/c of the increased blood volume and airway changes that occur normally w/ pregnancy)}

Question 56

_{Pulmonary Manifestations of Preeclampsia} What are cause of Pulmonary edema a/w Preeclampsia?

Answer 56

↑ capillary permeability ↓ colloid oncotic pressure Heart failure Circulatory overload

Question 57

Uteroplacental Manifestations of Preeclampsia:

Answer 57

**Vasoconstriction/occlusive lesions** --- **Hyperactive/Hypertonic Uterus** _{(could lead to premature labor)}

Question 58

_{Uteroplacental Manifestations of Preeclampsia} Vasoconstriction/occlusive lesions from Preeclampsia cause decreased intervillous blood flow (despite ↑ maternal BP). What are the possible negative consequences of decreased intervillous blood flow?

Answer 58

Uteroplacental hypoperfusion Placental Abruption ^{Ischemia/infarction → necrosis of supporting placental structure => Placental Abruption} Chronic fetal hypoxia Fetal malnutrition (IUGR) Preterm L/D Perinatal death

Question 59

_{Uteroplacental Manifestations of Preeclampsia} How could Hyperactive/Hypertonic Uterus from preeclampsia affect the process of labor?

Answer 59

Could lead to **premature labor**

Question 60

_{Uteroplacental Manifestations of Preeclampsia} T/F: Vasoconstriction/occlusive lesions from preeclampsia could lead to decreased intervillous blood flow despite increasedd in maternal BP

Answer 60

**True** Decreased intervillous blood flow occurs despite increase in maternal BP

Question 61

_{Uteroplacental Manifestations of Preeclampsia} Vasoconstriction/occlusive lesions → ↓ intervillous blood flow despite ↑ maternal BP - What are the consequences of this?

Answer 61

_Uteroplacental hypoperfusion_ Ischemia/infarction → necrosis of supporting placental structure =\> **Placental Abruption** Chronic fetal hypoxia Fetal malnutrition (IUGR) Preterm L/D Perinatal death

Question 62

Coagulation Manifestations of Preeclampsia:

Answer 62

**Consumption coagulopathy** ^{PLT adherence at sites of endothelial damage Activation of fibrinolytic system DIC} **Thrombocytopenia** ^{PLT <100K correlates with severe disease} **Prolonged PTT** **↓ fibrinogen** **↑ D-dimer (DIC specific)** ^{↑ incidence of placental abruption => DIC}

Question 63

_{Coagulation Manifestations of Preeclampsia} How does Consumption coagulopathy a/w Preeclampsia manifest?

Answer 63

PLT adherence at sites of endothelial damage Activation of fibrinolytic system DIC

Question 64

_{Coagulation Manifestations of Preeclampsia} Thrombocytopenia in severe preeclampsia manifest as a plt count of which values

Answer 64

**PLT \<100K** correlates with severe disease

Question 65

_{Coagulation Manifestations of Preeclampsia:} How is PTT in preeclampsia?

Answer 65

Prolonged PTT

Question 66

_{Coagulation Manifestations of Preeclampsia} How is fibrinogen in preeclampsia?

Answer 66

Fibrinogen is decreased

Question 67

_{Coagulation Manifestations of Preeclampsia} How are D-dimer in Preeclampsia?

Answer 67

Increased D-dimer (DIC specific) Increased incidence of placental abruption =\> DIC

Question 68

_{Obstetrical Management of Preeclampsia} What's the Definitive treatment of Preeclampsia?

Answer 68

Delivery of fetus & placenta

Question 69

_{Obstetrical Management of Preeclampsia} After Delivery of fetus & placenta, how soon do symptoms of preeclampsia begin to resolve?

Answer 69

Symptoms begin to resolve within 48 hrs

Question 70

_{Obstetrical Management of Preeclampsia} Until definitive treatment is possible, what are the Goals and Priorities of Obstetrical Management of Preeclampsia?

Answer 70

Control HTN Prevent seizures (eclampsia) Correct coagulopathies Improve organ perfusion

Question 71

_{Antihypertensive Therapy in the Management of Preeclampsia} What are the benefits of Antihypertensive Therapy in the Management of Preeclampsia?

Answer 71

Decrease risk of intracranial bleeding, placental abruption, seizures Improves organ perfusion

Question 72

_{Antihypertensive Therapy in the Management of Preeclampsia} When should Antihypertensive Therapy in the Management of Preeclampsia be initiated?

Answer 72

Initiate when **DBP** rises above **110 mmHg**

Question 73

_{Antihypertensive Therapy in the Management of Preeclampsia} Which specific antipypertensive modalities are used for the Therapeutic Management of Preeclampsia?

Answer 73

Vasodilators + plasma volume expansion

Question 74

_{Antihypertensive Therapy in the Management of Preeclampsia} In the Antihypertensive management of Preeclampsia, BP is NO to "normalize" BP. Rather the goal of therapy is DBP of 90 – 100 mmHg. Why is that?

Answer 74

Decreasing maternal BP will lead to decrease uterine perfusion pressure This could cause **Fetal distress!!!**

Question 75

_{Antihypertensive Therapy in the Management of Preeclampsia} Common drugs used in the Antihypertensive Therapy in the Management of Preeclampsia include:

Answer 75

**Hydralazine (IV)** ^{Direct arterial vasodilator Improves both renal & uteroplacental blood flow Good first-line drug} **Labetalol (p.o./IV)** ^{β & α- adrenergic antagonist - Acute/long term treatment Useful for treatment reflexive tachycardia} **Methyldopa (p.o.)** ^{Selective α2- adrenergic agonist Long-term only} **NTP** ^{Potent, immediate acting vasodilator of both capacitance & resistance vessels Use: Acute ↑ in BP (DL/extubation), Malignant HTN crisis Cautions: Prolonged use → cyanide toxicity Cyanide crosses placenta resulting in accumulation in fetus → detrimental to fetus}

Question 76

_{Antihypertensive Therapy in the Management of Preeclampsia} Benfits of **_Hydralazine_ (IV)** when used in Antihypertensive Therapeutic Management of Preeclampsia:

Answer 76

Direct arterial vasodilator Improves both renal & uteroplacental blood flow Good first-line drug

Question 77

_{Antihypertensive Therapeutic Management of Preeclampsia} Which characteristics of _Labetalol_ (p.o./IV) make it useful in the Antihypertensive Therapeutic Management of Preeclampsia? when is its use indicated?

Answer 77

_β & α- adrenergic antagonist_ Indicated for Acute/long term treatment Useful for the treatment of _reflexive tachycardia_

Question 78

_{Antihypertensive Therapeutic Management of Preeclampsia} Which characteristics of _Methyldopa_ (p.o.) make it useful in the Antihypertensive Therapeutic Management of Preeclampsia? when is its use indicated?

Answer 78

**Selective α2- adrenergic agonist** Indicated for _Long-term only_

Question 79

_{Antihypertensive Therapeutic Management of Preeclampsia} Which characteristics of **_NTP_** make it useful in the Antihypertensive Therapeutic Management of Preeclampsia? when is its use indicated?

Answer 79

Potent, immediate acting vasodilator of both capacitance & resistance vessels Indicted for _Acute increase in BP_ (DL/extubation), _Malignant HTN crisis_

Question 80

_{Antihypertensive Therapeutic Management of Preeclampsia} Why must caution be used w/ _prolonged use of NTP_ in the Antihypertensive Therapeutic Management of Preeclampsia

Answer 80

**Cyanide toxicity** Cyanide crosses placenta resulting in accumulation in fetus → detrimental to fetus

Question 81

_{Seizure Prophylaxis in Preeclampsia} Which drug 1st line agent in Seizure Prophylaxis during Preeclampsia?

Answer 81

**MgSO4** This is the Gold standard for Seizure Prophylaxis

Question 82

_{Seizure Prophylaxis in Preeclampsia} How does MgSO4 work in Seizure Prophylaxis during Preeclampsia?

Answer 82

Decreases CNS irritability Relaxes uterine & vascular smooth muscle tone =\> (↑ UBF & ↑ RBF)

Question 83

_{Seizure Prophylaxis in Preeclampsia} What are _MgSO4_ loading and maintenance doses for Seizure Prophylaxis during Preeclampsia?

Answer 83

Loading: 4-6 gm IV over 20” Maintenance: 1-2 gm/hr This is the Gold standard for Seizure Prophylaxis

Question 84

_{MgSO4 Toxicity} What's the Therapeutic level of MgSO4?

Answer 84

4-8 mEq/L of MgSO4

Question 85

_{MgSO4 Toxicity} Which MgSO4 levels are associated with Prolonged QT and/or Widened QRS?

Answer 85

**5-10** mEq/L of MgSO4 Prolonged QT and/or Widened QRS

Question 86

_{MgSO4 Toxicity} Which MgSO4 levels are associated with Loss DTR?

Answer 86

10-12 mEq/L of MgSO4 Loss DTR

Question 87

_{MgSO4 Toxicity} Which MgSO4 levels are associated with Respiratory depression?

Answer 87

12-15 mEq/L of MgSO4 Respiratory depression

Question 88

_{MgSO4 Toxicity} Which MgSO4 levels are associated with Respiratory arrest?

Answer 88

15-20 mEq/L of MgSO4 Respiratory arrest

Question 89

_{MgSO4 Toxicity} Which MgSO4 levels are associated with Cadiac arrest?

Answer 89

\> 20 mEq/L of MgSO4 Cadiac arrest

Question 90

_{MgSO4 Toxicity} What's the treatment for MgSO4 Toxicity?

Answer 90

**_Stop infusion_** if in toxic levels **Calcium gluconate** 10 ml of 10% solutions over 2” **Oxygen** **Airway** support/mechanical ventilation

Question 91

_{Seizure Prophylaxis in Preeclampsia} What are some notable undesirable effects of MgSO4?

Answer 91

**Enhances neuromuscular blockade of both depolarizing & NDMR's** ^{↓ presynaptic release of ACH ↓ sensitivity of end-plate to ACH} **↓ uterine tone → uterine atony** ^{=> ↑ PostPartum bleeding d/t boggy ueterus} **Enhances effects of sedative/opioids** **Readily crosses placenta** ^{→ ↓ neonatal muscle tone}

Question 92

_{Seizure Prophylaxis in Preeclampsia} How does MgSO4 Enhances neuromuscular blockade of both depolarizing & NDMR's?

Answer 92

Decreases presynaptic release of ACH Decreases sensitivity of end-plate to ACH

Question 93

_{Seizure Prophylaxis in Preeclampsia} Via which mechanism can MgSO4 cause increased PP bleeding?

Answer 93

Decrease uterine tone → uterine atony → **boggy ueterus**

Question 94

_{Seizure Prophylaxis in Preeclampsia} T/F: MgSO4 Enhances effects of sedative/opioids

Answer 94

**True**

Question 95

_{Seizure Prophylaxis in Preeclampsia} MgSO4 readily crosses placenta. What effect could this have on the neonate?

Answer 95

Decreased neonatal _muscle tone_

Question 96

_{Obstetrical Management in Preeclampsia} What are the goals of Obstetrical Fluid management in Preeclampsia?

Answer 96

Correct intravascular depletion with crystalloid Monitor U/O for effectiveness If remains oliguric or aggressive resuscitation necessary, guide by CVP measurements

Question 97

_{Obstetrical Management in Preeclampsia} Obstetrical correction of coagulopathies involves:

Answer 97

**PLT replacement** ^{< 20K during vaginal delivery < 50K if C/S required} **FFP/Cryoprecipitate** ^{if DIC evident}

Question 98

_{Obstetrical Management in Preeclampsia} Which plt count values warrant replacement if vaginal delivery?

Answer 98

**Plt \< 20K**

Question 99

_{Obstetrical Management in Preeclampsia} Which plt count values warrant replacement if C-S required?

Answer 99

**Plt \< 50K**

Question 100

_{Obstetrical Management in Preeclampsia} When is coagulopathy treated w/ FFP/Cryoprecipitate

Answer 100

if **DIC** evident

Question 101

_{Obstetrical Management in Preeclampsia} T/F: Invasive Monitoring is beneficial for Obstetrical Management of Preeclampsia

Answer 101

**False** Invasive Monitoring has Not proven beneficial for Obstetrical Management of Preeclampsia **Standard monitoring of BP & U/O acceptable** There are some acceptable indications to switch over to Invasive Monitoring

Question 102

_{Obstetrical Management of Preeclampsia} What are accepted indications to switch over to Invasive Monitoring in Obstetrical Management of Preeclampsia?

Answer 102

Refractory HTN Pulmonary edema Refractory oliguria unresponsive to fluid challenges Severe cardiopulmonary disease Obese

Question 103

_{Obstetrical Management of Preeclampsia} What are the benefits of _High dose corticosteroid therapy_ in the Obstetrical Management of Preeclampsia?

Answer 103

Improves fetal lung maturity Prevents further decline in PLT (actually increases PLT in HELLP syndrome)

Question 104

_{Obstetrical Management of Preeclampsia} T/F: High dose corticosteroid therapy in the Obstetrical Management of Preeclampsia is Effective only during antepartum period, not PP

Answer 104

**True** High dose corticosteroid therapy is Effective only during antepartum period, not PP

Question 105

_{Obstetrical Management of Preeclampsia} When should High dose corticosteroid therapy for the Obstetrical Management of Preeclampsia be initiated? How long should it be continued?

Answer 105

Initiated with PLT \< 100K Continue until LFT’s improve or PLT \> 100K

Question 106

_{Obstetrical Management of Preeclampsia} When High dose corticosteroid therapy is used for the Obstetrical Management of Preeclampsia, which drug is administered? at what dose?

Answer 106

Dexamethasone (Decadron) 10 mg IV every 12 hrs.

Question 107

_{Obstetrical Management of Preeclampsia} In the Obstetrical Management of Preeclampsia, what are indications for Labor Induction & Delivery?

Answer 107

\> 36 weeks gestation Fetal lung maturity Favorable cervix Refractory HTN despite conservative measures Evidence of maternal or fetal deterioration regardless of gestational age

Question 108

_{Obstetrical Management of Preeclampsia} Which anesthetic technique are appropriate when Labor Induction & Delivery are indicated in the Obstetrical Management of Preeclampsia?

Answer 108

**Epidural** vs. **Spinal** **GETA** Refer to the *_Anesthesia & Analgesia for Obstetrics_* lecture