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Principles II, Exam 1 > Preeclampsia > Flashcards

Preeclampsia Flashcards

1
Q

Etiology of Pre Ec

A

Spiral arteries narrowing
Increased uterine vascular resistance, 30-40% dec in uterine flow
Myometrium sm and narrow- responds readily to vasomotor stimuli and vasoconstriction

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2
Q

What is utero placental ischemia

A

Imbalance of two placental prostaglandins

  • increased vascular resistance
  • decreased intravascular volume
  • intimate detoriation
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3
Q

What are the results of utero placental ischemia

A

70% flow decrease

IUGR, fetal hypoxia, placental infarction

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4
Q

Prostacyclin

A 
Decreased presser effect in pregnancy
Potent vasodilator 
Inhibits platelet aggregation 
Decrease uterine activity
Increase uteroplacental blood flow
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5
Q

Thromboxane

A

Stimulates platelet aggregation and vasospasm: vasoconstriction
Increased sensitivity to angiotensin II - HTN
Incre uterine activity
Decreased utero placental blood flow
Increased in preEcl

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6
Q

Severe Pre E

A
  • SBP >160 DBP>100
  • > ## 5g/24 hr proteinuria, dip stick +3, +4
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7
Q

What contributes to generalized vasoconstriction

A

Increased:

Renin, angiotensin, aldosterone, catecholamines

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8
Q

Pre E - cardiac s/s

A

Hyperdynamic state
Inc: CO, BP, PCWP
Dec: plasma volume (30-40%), COP, plasma protein,
3% pulmonary edema
Na and H2O retention, CHF, cerebral edema
Hemoconcentration due to hypovolemia

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9
Q

Coagulation in Pre E

A

Low platelets

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10
Q

What does Betamethasone do to coagulation

A

Immune mechanism that Destroys platelets

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11
Q

Renal/GI

A

Inc: liver enzyme, GFR, creatine clearance
HELLP: ARF, peri portal hemorrhage, ischemic lesions, swelling and subscapular hematoma of liver

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12
Q

What is the leading cause of death in pre E

A

ICH

EEG 75% of PE will have abnormal

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13
Q

P50 numbers of oxyHgb

  1. Non Pregnant
  2. Normal pregnant
  3. Preeclamptic pregnant
A
  1. 26.7 non pregnant
  2. 30.1 normal pregnant
  3. 24.4 Preeclamptic pregnant
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14
Q

What happens to placenta/uterus

A

Small, infarcted, premature aging, calcification, hyperactive, sensitive to oxytocin

Marginal placental function

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15
Q

Mag function

A
  1. Reduces hyper-reflexia and controls convulsions: dec Ach
  2. Mild vasodilator: depresses catecholamine, release smooth muscle
  3. Increases prostacyclin production
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16
Q

Mag s/s

A
  • Weakness, resp insufficiency, cardiac failure
  • Assess and monitor deep tendon reflexes
  • Inc sensitivity to NDMR
  • Dec muscle tone in neonates
  • Resp depression, apnea at birth
17
Q

Mag dose

A

2-4 gm/15 min loading dose
2-4g/hr continuous infusion
Maintain 24-48 hrs after delivery
Maintain blood level of 4-8 mEq/L (normal 1.5-2.0)

18
Q

Rx of Mg overdose

A

Mother: 10cc of 10% Ca gluconate over 10 min
Neonate: IV Ca 10gm/dl (10%) .5-1 ml slowly, monitor HR

19
Q

Ant HTN meds

A
  1. Hydralazine: inc utero placental blood flow, long onset time
  2. Na nipride/NTG : emergent situations only
  3. Beta blockers:
    - labetalol safe for mom
    - esmolol crosses placenta barrier
  4. Ca channel blockers
    - improve placental/renal perfusion, increases UO
    - augment Mg (acts as Ca blocker)
20
Q

Rx for convulsions

A

Propofol
Versed or MgSO4 bolus
Mannitol or decadron for cerebral edema

FIRST: Secure airway

21
Q

Which ant HTN med helps to improve UO

A

Ca channel blocker

Improves placental blood flow

22
Q

EKG changes with high Mag

A

5-10 PQ prolong, QRS widens

10 loss of DTReflexes

23
Q

Main point for anesthesia

A
  1. Coags: b4 regional
  2. Mag gtts = sensitive to NDMR, no defasiculation dose
  3. GA: RSI, prop or etomidate, no ketamine, labetalol
24
Q

What does HELLP stand for

A 
Hemolytic anemia 
Elevated 
Liver enzymes
Low
Platelets
25
Q

What is the hallmark of HELLP

When does it develop usually

A

Hemolysis

3rd trimester, usually develops suddenly

26
Q

HELLP s/s

A

Epigastric pain, n/v
Malaise
Flu like symptoms
Platelet count

27
Q

Rx for HELLP

A 
Delivery
C - section under GA
Corticosteroids for coagulopathy 
Control BP
Supportive: blood products, hemodynamics monitoring
28
Q

Preeclampsia characteristics

A

HTN
Edema
Protenuria
Anuria

Principles II, Exam 1 (8 decks)

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