NM 621 exam 1 : SAB & preeclampsia Flashcards
(53 cards)
chronic hypertension
BP >140/90
Before 20 weeks of gestation
No proteinuria or stable proteinuria
superimposed preeclampsia
BP>140/90
new or increase proteinuria
development of increase BPs or HELLP syndrome
preeclampsia
BP>140/90
after 20 weeks gestation
proteinuria (+1 dipstick or >3–mg) or absence of proteinuria + thrombocytopenia, renal insufficiency, impaired liver functions, pulmonary edema, or cerebral or visual symptoms
gestational hypertension
BP>140/90
no proteinuria and not symptomatic
management for GHTN or preeclampsia w/o severe features
close monitoring serial assessment of maternal symptoms DAILY fetal kick counts BP 2x per week WEEKLY Lab : CBC & liver enzymes
when to referral preeclampsia
when symptomatic
prophylactic mag sulfate when hospitalized with symptomatic preeclampsia.
HELLP
hemolysis
Elevated liver enzymes
low platelets
complaints of HELLP
90%–> malaise fatigue and nonspecific complaints
prevalence–> N/V headache and/or abdominal pain
66% –> elevated BP
Gestational Hypertension
BP>140/90 for the 1st time during MID-pregnancy
no proteinuria
B/P returns to normal w/in 12 weeks postpartum
final dx made postpartum
50% of women dx with GHTN between 24-35weeks develop preeclampsia
mild Preeclampsia
BP >140/90
2 BP readings 4-6 hours apart
Proteinuria >300mg/24 hours urine or >+1 on dipstick on 2 specimens ( on 2 samples 4-6 hours apart)
occurs after 20 weeks gestation
may see: elevated reflexes
elevated hemoglobin d/t hemoconcentration
mild edema
severe preeclampsia
BP >160/110mmHG on 2 BP readings 4-6 hours apart proteinuria >5g/24 hours urine or >+3 on dipstick (on 2 samples 4-6 hours apart) occurs after 20 weeks gestation may see: epigastric pain visual disturbances headaches clonus dim. renal function ( increase BIN; serum creatinine >1.2mg/dL; decreased creatinine clearance) thrombocytopenia oliguria edema
Eclampsia
Grand mal seizures that cannot be attributed to other causes in a woman with preeclampsia
occurs in 0.1% of women with preeclampsia
cause: fetal distress, abruption, death
chronic HTN
REFERRAL
Chronic HTN increased risk for
FGR preterm birth preeclampsia placental abruption pulmonary edema renal failure perinatal mortality 3-4 times greater.
chronic HTN superimposed w/ preeclampsia
dx HTN prior to 20 weeks gestation and new onset proteinuria >300mg/24 hour after 20 weeks gestation
thrombocytopenia after 20 weeks gestation
worsening of HTN as pregnancy progresses
Preeclampsia etiology
abnormal placentation
inflammatory changes provoke endothelial cell injury
mild-severe microangiopathy of target organs such as brain liver kidney placenta
extreme case lead to liver failure, renal failure DIC CNS abnormalities
giving birth is only cure
preeclampsia risk factors
nulliparity multifetal gestation age extremes 35 African American race DM prior hx preeclampsia family hx of HTN or preeclampsi obesity limited exposure to partner sperm (new partner --immunologic factors involved)
smoking does not increase risk for preeclampsia
Data gathering
objective:
(1) BP
(2) urine for protein
if 2 positive then :
check for risk factors
weight gain pattern
edema
DTR
epigastric tenderness/liver margins
opthalmic exam fo papilledema
Data gathering
subjective:
Headaches ?
dizziness ?
blurry vision
epigastric pain
Best position to take BP
after rest
UPRIGHT
NO tobacco or caffeine within 30 minutes of measurement.
LABS for preeclampsia
CBC incl. platelets
24 hour urine or albumin to creatinine ratio
liver enzymes (AST, LDH, ALT)
renal function tests (Creatinine clearance, serum uric acid, BUN, serum creatinine)
COAGULATION studies (PTT, fibrinogen, PTPT) if low platelets)
how often do labs done if stable
WEEKLY LABS
proteinuria (preeclampsia)
> 300mg/ 24h
urine dipstick (preeclampsia)
> 1+
