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Pre-eclampsia & Eclampia Flashcards

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1
Q

When in pregnancy do you have to consider pre-eclampsia/eclampsia?

A

> 20 weeks to 6 weeks postpartum

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2
Q

What is the classic triad of pre-eclampsia?

A

HTN
Proteinuria
Edema

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3
Q

What is considered mild pre-eclampsia?

A 
BP: > 140/90 (but <160/110)
Proteinuria: = to 3+++ on dipstick or:
Hyperreflexia/Clonus 2 or more beats
Headache/vision changes
RUQ pain
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4
Q

What is considered severe pre-eclampsia?

A

BP: >160/10
Proteinuria >3+++ OR:
Increase CR / Liver enzymes
Plt. <50,000

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5
Q

Highest incidence of pre-eclampsia/eclampsia?

A

Native americans

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6
Q

Pre-eclampsia/ eclampsia predisposes to?

A 
Abruptio placenta
DIC
Cerebral hemorrhage
Hepatic failure
Acute renal failure
Increased rate of c-section
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7
Q

Pre-eclampsia/eclampsia primarily occurs

A

After 2nd trimester of pregnancy (contribute to intrauterine fetal death and perinatal mortality)

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8
Q

Causes of perinatal death related to pre-eclampsia

A

Uteroplacental insufficiency

Abruptio placenta

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9
Q

This is when the seizures begin, caused from the cerebral effect of pre-eclampsia

A

Eclampsia (seizures)

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10
Q

Pregnancy specific syndrome ONLY
Affects multi system with the body
Categorized mild to severe

A

Pre-eclampsia

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11
Q

Causes of eclampsia seen early in gestation (<28 weeks)

A

Maternal age is >25 years
Multigravida
Chronic hypertension or renal disease

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12
Q

HELLP syndrome

A

Hemolysis
Elevated liver enzymes
Low platelet

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13
Q

This prevents seizures
Causes diuresis within 24-48 hours and lowers BP
Used to prevent eclampsia seizures

A

Magnesium sulfate

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14
Q

Cardiovascular changes that occur within a normal pregnancy

A

Increase HR 85-90 bpm r/t increased blood flow
Increased cardiac output
Increased BP

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15
Q

Hemodynamic changes that occurs within normal pregnancy

A

Increased cardiac output
NA/H2O retention—> blood volume retention
Decreased systemic vascular resistance and systemic BP
*reach peak during 2nd trimester
*contribute to optimal growth and development
*protect mother from risks of delivery

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16
Q

Normal transition that happens to the vessels in pregnancy

A

Uterine spiral arteries transform from thick to flaccid which accommodates the increased circulating blood volume. Supported by angiogenesis, prostaglandin balancing with thromboxane and nitrous oxide.

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17
Q

Abnormal transition that occurs with pregnancy and leads to hypertensive problems (pre-eclampsia)

A

Imbalance between prostaglandin and thromboxane (constrictor) and there is a decreased production in nitrous oxide so vessels remain constricted. Vessels fail to transform and remain thick walled (cytotrophic)

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18
Q

New theory for what causes pre-eclapmsia

A

HHcy (hyperhemocysteinemia)

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19
Q

Effect of pre-eclampsia on the cardiovascular system

A

Increased intracellular volume

Decreased intravascular volume

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20
Q

Effect of pre-eclampsia on the renal system

A

Decreased renal perfusion which leads to tubular necrosis and oliguria

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21
Q

Effect of pre-eclampsia on the liver

A

Liver damage

Subcapular hematoma

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22
Q

Expected lab diagnosis with pre-eclampsia

A

Decrease GFR

Increase BUN, Crea, Proteinuria

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23
Q

Effects of pre-eclampsia on the nervous system

A

Vasospasm causes irritability and cerebral edema which causes headache

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24
Q

Effects of pre-eclampsia on the eyes

A

Retinal blood vessels are impacted from cerebral edema

Scotoma

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25
Effect of pre-eclampsia on the pulmonary system
Change in vascular permeability leading to pulmonary edema
26
Effect of pre-eclampsia on the placenta
Placental infarcts lead to decreased in healthy tissue available for perfusion and oxygenation Decreased perfusion and oxygenation
27
2 assessment findings in pre-eclampsia but does not need to diagnose it
Proteinuria and edema
28
Edema is common in pregnancy, abnormal amount?
Weight gain >1.5 kg i 2nd trimester or | >5kg increase per week in 3rd trimester
29
Findings in severe pre-eclampsia (Maternal)
``` BP: >160/110 mmHg Proteinuria: 3-4+ dipstick Crea: >2mg/dL Thrombocytpenia: <50,000 Headache, blurred vision, scotoma Persistent epigastric pain or RUQ pain Elevated liver enzymes 1-4* pitting edema Dyspnea, pulmonary edema HELLP syndrome ```
30
Findings in severe pre-eclampsia (Fetal)
IUGR SGA Oligohydramnios Bradycardia
31
Fetal assessment for mild and severe s/s
``` Obtain kick counts Non-stress test (should have 2 in 20 mins) Contraction stress test BPP-AFI (26-28 weeks) Amniocentesis- L/S ration and PG Ultrasound (every 3-4 weeks) Doppler velocimetry ```
32
Eclampsia is characterized by
Cerebral vasospasm Edema Hemorrhage and/or ischemia Loss of autoregulation of blood flow due to HTN Self-limiting seizures (last 2-4 mins, either focal, multi focal or generalized)
33
Maternal s/sx of eclampsia (preceding seizure)
``` Scotoma, blurred vision, transient loss of vision Epigastric pain Vomiting Severe persistent frontal headache Hyperreflexia Pulmonary edema and cyanosis ```
34
Fetal s/sx of eclampsia (leading to seizure activity)
``` Hypoxia Bradycardia Lates Absent to minimal variability Compensatory tachycardia due to decrease O2 ```
35
Home-care for antepartum women
Increased calcum diet (1500mg), moderate salt intake and protein Bed rest-lateral decubitus position Monitor fetal kick counts Low dose aspirin to lower thromboxane
36
Antidote for magnesium sulfate toxicity
Calcium gluconate 1g IV within 3 mins | Increase O2 to 10L with mask
37
Magnesium sulfate therapeutic level
4.8-8.4
38
Fetal side effects of magnesium sulfate toxicity
Hypotonia and lethargy at birth Hyperglycemia Hypcalcemia
39
Common corticosteroid used in re-eclampsia
Betamethasone for fetal lung development | 12.5 mg x 2 doses in 2 days
40
Most common hypertensive disorder in pregnancy
Pre-eclampsia
41
Only cure to pre-eclampsia
Deliver the baby
42
Parameters for HTN in pre-eclampsia
BP >140/90 during 2nd or 3rd trimester (BP elevation should be present in 2 separate occasions, 4-6 hours apart in no more than 7 days) Increased in 30 mmHg systolic or 15 mmHg diastolic MAP >105 mmHg
43
Muscular spams involving repeated, often rhythmic contractions
Clonus
44
CNS irritability in the patellar and brachial reflexes
Hyperreflexia | Indicates high risk for seizures
45
Best indicator of an impending seizure
Epigastric pain
46
Best treatment for pre-eclampsia
Magnesium sulfate
47
Medication to control HTN
Hydralazine
48
Whys is seizure dangerous to fetus?
During seizures, the fetus is not getting any O2. Although seizure are self-limiting it still last for 3-4 minutes, way too long for the fetus to go without O2.
49
Symptoms of HELLP
``` Malaise Epigastric pan N/V Flu-like symptoms Labor tends to go faster ```
50
Pre-eclampsia etiology and pathophysiology
Unknown cause but theories involves: Abnormal placentation and an exaggerated immune response that results in: Vasospasm (sudden constriction) Hypoperfusion Endothelial damage (platelet adherence, fibrin deposition)
51
Pre-eclampsia risk factors
``` Primagravida <20 or >35 years African american or hispanic Family history Mutifetal gestation Diabetes mellitus Obesity Renal/liver impairment ```
52
Cardiovascular manifestation
Increased lifelong cardiovascular risk Hypertension (arteriolar constriction) Edema (extravascular blood volume expansion leaking from vessels) Decreased platelets (micro-intravascular coagulation trying to repair damage to vessels, wears out platelets) Hemoconcentration (decreased vascular volume increases blood viscosity and hematocrit)
53
Renal manifestation
Decreased perfusion reduces GFR (oliguria and increased serum llevels of Na, BUN, UA, LDH and Crea) Degenerative changes in glomeruli (edema, proteinuria)
54
Hepatic manifestion
Decreased perfusion reduces liver function and causes hemorrhage (epigastric pain, RUQ, nausea, vomiting, increase AST/ALT) Stretching of the hepatic capsule *fibrin deposition causes coagulopathies and stasis o blood in the liver) Lesions Edema
55
Why give surfactant to pregnant woman with pre-eclampsia
Assist in lung development of the baby’s lungs
56
Partial tear of placenta from uterus
Placenta abruption
57
Placenta is positioned over the cervix
Placenta previa
58
Thinning of cerix
Effacement
59
Placenta abruption presentation
Painful separation from the uterine from the uterine wall accompanied by bleeding
60
Increases risk for placenta previa
Previous cesarean section, induced abortion
61
Placenta previa presentation
Painless vaginal bleeding in 2nd or 3rd trimester
62
Why are patients at risk for hemorrhage who have placenta abruption or previa?
Uterus has little tone —> involution is difficult
63
What is involution
Get the uterus back to where i should be
64
Marginal placenta previa
Placenta is next to the cervix but does not cover the opening
65
Partial placenta previa
Placenta covers part of the cervical opening
66
Complete placenta previa
Placenta covers all of the cervical opening

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