OB exam 1 - HTN disorders Flashcards
(52 cards)
HTN causes an increased risk of
placental abruption, preterm delivery, and intrauterine growth restriction
how to take a correct BP
-the cuff size (width) should be ~40% of the arm and 80% of the arm circumference should be covered by the cuff
-pt at rest for 5 mins prior
-pt in sitting or semi reclining position
-arm at least w/ heart
gestational HTN dx
SBP >/140 or DBP >/ 90
-occurs after 20wks
-no proteinuria
-if still elevated 6wks after delivery, pt is dx w/ chronic htn
Preeclampsia
increased BP after 20 wks gestation accompanied by proteinuria
categorized by mild or severe
risk factors for preeclampsia
-chronic HTN
-chronic renal disease
-diabetes
-rH incompatibility
-primigravidity (1st preg)
-family hx
-maternal age <20 or >40
-multiple gestation
-IVF
-new paternity
what decreased in preeclampsia that can contribute to the etiology
prostacyclin which is a vasodilator so vasoconstriction can occur and there is reduced renal perfusion which can lead to hypoxia of baby
pathophys of a normal pregnancy
-inc blood plasma volume
-vasodil
-dec systemic vascular resistance
-inc CO
-dec colloid osmotic pressure
pathophys of preeclampsia
inc BP leading to dec placental perfusion causing
1)vasco
2)activation of coagulation cascade
3)intravascular fluid redistribution
how do we prevent preeclampsia for pt’s who are at risk
start 81mg of low dose aspirin between 12-28wk
where does funneling of preeclampsia occur and what does it prevent
funneling occurs between the endometrium and myometrium and it prevents good blood flow to the uterus
preeclampsia symptoms
-epigastric pain
-CNS (headache, blurred vision)
-bleeding
-N/v
hemolytic issues in preeclampsia
-low platelets
-aqueous liver enzymes
-DIC
-renal failure
-HELLP syndrome
what do capillary leaks cause in preeclampsia
-proteinuria
-facial edema
-pulmonary edema
-ascites
-pleural effusions
fetal manifestations of preeclampsia
-chance of placental abruption
-abnormal umbilical artery doppler d/t abn blood flow
-low ammonitic fluid
-growth restriction
-stillbirth
symptoms of severe preeclampsia
-visual disturbances & headaches
-fetal growth restrictions
-irritability/hyperreflexia
-retinal edema, retinal arteriolar narrowing d/t dec perfusion
if the kidneys are not being perfused well during preeclampsia, what are the effects
-oliguria
-proteinuria
-general edema
what are labs to be checked for preeclampsia
CBC, liver enzymes (LDH, AST, ALT), chemistry panel (BUN, creatinine, glucose, uric acid), type & screen and/cross mathc
+24 hr urien collection for protein & creat clearance
mild preeclampsia dx
-SBP >/ 140 or DBP >/ 90 on 2 occasions at least 4hrs apart w/ previously normal BP
-proteinuria >300mg/24hr
-pro:creat >/ 0.3
~edema
severe preeclampsia dx
-SBP >/ 160 or DBP >/ 110 on 2 occasions at least 4 hrs apart while pt is on bedrest (unless on anti htn)
-proteinuria >/ 300mg/24hr
-platelet count <100,000
-pulmonary edema
-cerebral or vision changes
-liver enzymes > twice the upper limit
-epigastric pain
home mgt of mild preeclampsia
-education to recognize worsening preeclampsia
-encourage frequent rest, lateral position
-daily BP & wt
-daily fetal movement count
if home mgt of preeclampsia is not successful, what is hospital mgt
-bed rest
-daily wts
-daily pressure 4x a day
-diet: mod to high pro, moderate Na
-fetal movement assessments
what are the major difference in check between GHTN & preeclampsia
GHTN: check NST 1x/wk & check for protein
Pre: do not need to check protein bc we know it is present & NST 2x/wk
what does a deep tendon reflex tell us
how irritated the CNS is
important bc the most irritated means the higher chance for a seizure
what does preeclampsia mean
“before the seizure”
