Tuesday, 2-28-Hypertensive disorders in pregnancy (Wootton) Flashcards Preview

Repro 2-Final > Tuesday, 2-28-Hypertensive disorders in pregnancy (Wootton) > Flashcards

Flashcards in Tuesday, 2-28-Hypertensive disorders in pregnancy (Wootton) Deck (21):
1

maternal risks for HTN in pregnancy?

-MI
-cardiac failure
-CVA
-renal and hepatic failure

2

fetal complications for HTN in pregnancy?

-fetal growth restriction
-preterm birth
-placental abruption
-stillbirth
-neonatal death

3

definition of HTN (in mmHg)?

sustained BP higher than 140/90

4

when is gestational HTN recognized?

when does preeclampsia occur?

gestational HTN recognized after 20 wks gestation

preeclampsia occurs after 20 wks and coexists w/proteinuria

5

for chronic HTN evaluation, how do you assess for maternal end-organ damage?

CBC
glucose
CMP
24 hr urine for total protein
EKG

6

for chronic HTN evaluation, how do you assess for fetal well-being?

initial US for accurate dating
screening US
growth US monthly after 28 wks
antepartum fetal testing to begin 32-34 wks gestation

7

definition of mild HTN (in mmHg)?

BP < 160/110 mmHg

8

how do you dx preeclampsia? symptoms?

dx: HTN, proteinuria, (edema)

symptoms: scotoma, blurred vision, epigastric and/or RUQ pain, Headache

9

Laundry list of risk factors for developing preeclampsia?

-age (<20 and >35)
-primigravid
-multiple gestation
-hydatidiform mole
-diabetes
-thyroid disease
-chronic HTN
-renal disease
-collagen vascular disease
-antiphospholipid syndrome
-prior hx of preeclampsia (increased by 18%)

10

what happens to the following systems with preeclampsia?

Brain:
Heart:
Lungs:

brain--> cerebral edema, possibly fibrinoid necrosis, thrombosis, micro infarcts, and petechial hemorrhages

heart --> absence of normal intravascular volume expansion (3rd spacing), reduction in circulating blood volume

lungs --> noncardiogenic pulm edema

11

what happens to the following systems with preeclampsia?

liver:
kidneys:
eyes:

liver --> subcapsular hematoma leading to liver rupture, stretching of glisson's capsule results in RUQ pain

kidneys --> swelling and enlargement of glomerular capillary endothelial cells, narrowing of capillary lumen

eyes --> retinal vasospasm, retinal edema

12

what is the BP in MILD preeclampsia? Proteinuria? symptoms?

BP is >140/90 but <160/110

proteinuria >300 mg/24 hr urine but <5 gms/24 hr

asymptomatic

13

what is the BP in SEVERE preeclampsia? Proteinuria? is there oliguria? symptoms?

BP systolic >160 or diastolic >110 (2 occasions 4 hrs apart)

proteinuria of at least 5 gm/24 hr or 3+ protein on 2 random urine dips at least 4 hrs apart

Yes, oliguria (<500 ml in 24 hrs) --> renal insufficiency (serum Cr >1.1)

Symptoms: cerebral or visual disturbances, pulm edema, epigastric or RUQ pain, elevated liver enzymes, thrombocytopenia

14

exam findings of preeclampsia? lab findings?

exam: Brisk reflexes, clonus, (edema)

lab: Increase ---> hematocrit, LDH, AST/ALT, uric acid
also get thrombocytopenia

15

management of preeclampsia WITHOUT severe features at LESS THAN 37 weeks gestation?

bed rest
2x weekly antepartum testing
fetal growth US every 3-4 weeks
office visits and lab eval
possible hospitalization

16

management of preeclampsia WITHOUT severe features BETWEEN 37-40 weeks gestation?

-if favorable cervix-induction
-if unfavorable cervix-use cervical ripening agent to begin induction

17

management of SEVERE preeclampsia?

-immediate hospitalization
-delivery if >34 weeks
-Manage BP w/: Hydralazine, labetalol, nifedipine
-if <37 wks administer corticosteroids and work towards delivery as long as pt and fetus stable

18

this drug is administered IV for preeclampsia with severe features. It is used for seizure prophylaxis.

MgSO4

19

concerns with MgSO4 administration? how do you reverse these concerns? how long do you administer MgSO4 after delivery?

can overload and result in resp compromise and cardiac arrest (fluid restriction to prevent overload)

Calcium gluconate to reverse effects

continue for approx 24 hrs after delivery

20

first thing you do in eclampsia? 1st line tx?

protect the airway

MgSO4

21

after dx a pt with HELLP, what is the next step in management?

immediate delivery