UW htn (02-18) (1)

Question 1

table. Chronic HTN definition?

Answer 1

sAKS >=140 and/or dAKS >=90 prior to conception or 20 weeks gestation

Question 2

table. gestational HTN definition?

Answer 2

new onset elevated BP at >= 20 weeks gestation

NO PROTEINURIA or end-organ damage

Question 3

table. preeclampsia. definition?

Answer 3

new onset elevated BP at >= 20 weeks gestation
AND
proteinuria OR end-organ damage

Question 4

table. eclampsia. definition?

Answer 4

preeclampsia AND new onset grand mal seizures

Question 5

table. chronic HTN with superimposed preeclampsia. definition?

Answer 5

chronic HTN AND one of the following:
a) new onset proteinuria or worsening of exiting proteinuria at >=20 weeks gestation
b) sudden worsening of HTN
c) signs of end-organ damage

Question 6

notes. chronic HTN maternal complications.

Answer 6

Superimposed preeclampsia, Postpartum hemorrhage, Gestational diabetes, Abruption placentae, Cesarean delivery

Question 7

notes. chronic HTN fetal complications.

Answer 7

Fetal: Fetal growth restriction, Perinatal mortality, Preterm delivery (incr. SVR 1. and arterial stiffness  placental dysfunction), Oligohydramnios (Note: poorly controlled diabetes leads to polyhydramnios)

Question 8

table preeclampsia. risk factors? 5

Answer 8

Nulliparity
Obesity
Preexisting medical condition (eg SLE, chronic HTN)
Multiple gestation
Advanced maternal age

Question 9

table preeclampsia. again definition.

Answer 9

New onset HTN (sAKS >=140 and/or dAKS >=90) at >20 weeks gestation
AND
Proteinuria OR signs/symptoms of other end organ damage

Question 10

table preeclampsia. severe features. BP?

Answer 10

Severe HTN (sAKS >=160 and/or dAKS >=110).

Question 11

table preeclampsia. severe features. PLT?

Answer 11

<100k.

Question 12

table preeclampsia. severe features. liver?

Answer 12

Elevated transaminases (2x upper limit of normal)

Question 13

table preeclampsia. severe features. pulmonary?

Answer 13

pulmonary edema

Question 14

table preeclampsia. severe features. CNS?

Answer 14

visual or cerebral symptoms (eg headache)

Question 15

table preeclampsia. Mx. If <37 weeks and no severe features?

Answer 15

expectant

Question 16

table preeclampsia. Mx. If >=37 weeks (or >= 34 weeks with severe features)?

Answer 16

delivery

Question 17

table preeclampsia. Mx. Severe range BP?

Answer 17

iv labetalol, iv hydralazine, PO nifedipine

UW case buvo hydralazine for rapid Mx. Mehlman irgi sita zymejo

Question 18

table preeclampsia. Mx. seizures prophylaxis?

Answer 18

MgSO4

Question 19

Preeclampsia prevention. definition?

Answer 19

new onset HTN and proteinuria and/or end organ damage at >20 weeks gestation

Question 20

Preeclampsia prevention. high risk factors? 6

Answer 20

Prior preeclampsia
CKD
chronic HTN
DM
multiple gestation
Autoimmune disease

Question 21

Preeclampsia prevention. moderate risk factors? 3

Answer 21

obesity
advanced maternal age
nullparity

Question 22

Preeclampsia prevention. prevention?

Answer 22

low-dose aspirin at 12 weeks gestation

Question 23

Stroke due to preeclampsia. notes. mechanism nr1. coagulation system.

Answer 23

Activation of coagulation system, plt aggregation and vascular microthrombi formation –> cerebral vessel occlusion (ischemic stroke)

Question 24

Stroke due to preeclampsia. notes. mechanism nr 2. blood floow

Answer 24

dysregulated cerebral blood flow –> inappropriate cerebral vasospasm –> incr. perfusion pressure –> rupture of intracerebral vessels (hemorrhagic stroke)

Question 25

Stroke due to preeclampsia. notes. what about CT?

Answer 25

most patients with preeclampsia do not require CT scan but those with FOCAL NEUROLOGIC DEFICITS require a CT SCAN OF THE HEAD to evaluate for possible stroke and help guide management.

Question 26

eclampsia table. CP?

Answer 26

HTN, typically severe (ie SBP>=160 or DBP >= 110) Seizures, typically tonic-clonic with postictal phase severe headache visual disturbances (ie scotoma) hyperreflexia proteinuria

Question 27

eclampsia table. Dx? 2

Answer 27

mainly clinical Bilateral frontal lobe edema on CT scan of head

Question 28

eclampsia table. Mx? 3

Answer 28

Mg infusion antihypertensive agent for severe hypertension delivery

Question 29

algorithm of patho of pulmonary edema in pre/eclampsia. mechanism

Answer 29

generalized arterial vasospasm (systemic HTN) --> incr. afterload against which the heart is pumping -> incr. pulmonary capillary pressure --> pulmonary edema

Question 30

algorithm of patho of pulmonary edema in pre/eclampsia. other 3 mechanisms?

Answer 30

decr. albumin decr. renal function incr. vascular permeability

Question 31

notes. postpartum preeclampsia. onset?

Answer 31

preeclampsia can present in postpartum patients up to 6 weeks after delivery

Question 32

notes. postpartum preeclampsia. CP?

Answer 32

severe headache in bilateral occipital or frontal regions (most common presentation). this headache does not improve with paracetamol or NSAIDs

Question 33

anti-HTN drugs during pregnancy. first line drugs? 4

Answer 33

BAB (labetalol) CCB (nifedipine) hydralazine methyldopa

Question 34

anti-HTN drugs during pregnancy. second line? 2

Answer 34

clonidine thiazine diuretics

Question 35

anti-HTN drugs during pregnancy. what contraindicated? 5

Answer 35

ACEI ATII blockers direct renin inhibitors nitroprusside mineralcorticoid receptor antagonists (spironolactone)

Question 36

UW. HELLP table. CP? 5

Answer 36

Nausea/vomiting RUQ pain Headache visual changes HTN

Question 37

UW. HELLP table. Labs?4

Answer 37

Microangiopathic hemolytic anemia elevated liver enzymes thrombocytopenia +/- proteinuria

Question 38

UW. HELLP table. Tx? 3

Answer 38

Delivery MgSO4 for seizure prophylaxis Antihypertensives

Question 39

UW. HELLP table. complications 5

Answer 39

Abruptio placentae Subcapsular liver hematoma Acute renal failure pulmonary edema DIC

Question 40

UW. Tx of preeclampsia. Drugs antihypertensive 3 groups?

Answer 40

Hydralazine iv labetalol iv [dont give if bradycardia] nifedipine PO

Question 41

UW. Tx of preeclampsia. 3 groups antihypertensive. Indication?

Answer 41

lower BP acutely to decr. stroke risk

Question 42

UW. Tx of preeclampsia. MgSO4 iv or im - indication?

Answer 42

Prevent or treat eclampti seizure

Question 43

UW. Tx of preeclampsia. Methyldopa, a centrally acting adrenoreceptor antagonist, is safe during pregnancy but more appropriate for treating chronic hypertension due to slow onset and relatively low potency.

Answer 43

.