Term
| what are the different classifications of HTN in pregnancy? |
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Definition
| gestational HTN, preeclampsia/eclampsia, preeclampsia superimposed on chronic HTN, and chronic HTN |
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Term
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Definition
| BP greater than or equal to *140/90 w/no hx of HTN prior to pregnancy. no proteinuria. BP *returns to normal in less than 12 wks post partum (can't dx until you see this). other s/s of preeclampsia (such as thrombocytopenia) |
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Term
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Definition
| BP greater than or equal to 140/90 *after 20 wks gestation. proteinuria greater than or equal to *300 mg/24 hrs or at/greater than +1 on dipstick urine (but need multiple samples). |
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Term
| what is severe preeclampsia? |
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Definition
| BP at/greater than 160/110 2x 6 hours apart at bedrest. proteinuria at/greater than 5 gms/24 hrs or +3 on random samples 4 hrs apart. oliguria < 500 cc/24 hrs. cerebral/visual disturbances. pulmonary edema. **persistent RUQ/epigastric pain**. elevated LTFs. thrombocytopenia. |
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Term
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Definition
| a branch of severe preeclampsia: H for hemolysis, EL for elevated liver enzymes, and LP for low platelets |
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Term
| is maternal thrombocytopenia a fetal indication for c-section? |
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Definition
| no, there is no increased risk of fetal thrombocytopenia even w/maternal thrombocytopenia |
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Term
| what is the risk w/preeclampsia? |
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Definition
| even mild preeclampsia (proteinuria/HTN) in pregnancy *significantly increases the risks of morbidity/mortality to BOTH mother and fetus |
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Term
| why is the epigastric/RUQ such an ominous sign in a pregnant pt? |
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Definition
| this may be indicative of edema against glisson's capsule, hepatic ischemia/hepatocellular necrosis, elevated serum hepatic transaminase levels, and possible hepatic infarction/rupture of a subcapsular hematoma (rare). thus, these are all *indications to deliver* |
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Term
| what does thrombocytopenia in the pregnant pt indicate? |
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Definition
| worsening preeclampsia along w/vasospasm causing microangiopathic hemolysis, activation/aggregation of platelets, and gross hematuria which causes hemoglobinuria/hyperbilirubinemia (indications of severe disease) |
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Term
| is degree of BP increase a good indicator of severe preeclampsia? |
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Definition
| no, need to take all factors into account |
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Term
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Definition
| seizures (before/during/after labor) in a preeclamptic pt which cannot be attributed to any other causes. (25% of all eclamptic seizures occur > 48 hrs post partum) |
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Term
| what characterizes superimposed preeclampsia? |
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Definition
| NEW proteinuria (after none in the first 20 wks) at/greater than 300 mg/24 hrs in pts w/chronic HTN OR a sudden increase in proteinuria/BP/thrombocytopenia (< 100,000/mm3) in pts w/HTN and proteinuria before 20 wks. (this means that chronic HTN pts need to have renal function/24 hour urine tested early in pregnancy - est baseline) |
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Term
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Definition
| BP at/greater than 140/90 before pregnancy or dxed at < 20 wks gestation (and not related to gestational trophoblastic disease) OR HTN dxed 1st after 20 wks BUT continues > 12 wks post partum |
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Term
| what are the effects of chronic HTN on pregnancy? |
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Definition
| an increase in premature births (as high as 2/3x), IUGR, fetal demise (2-4x), placental abruption, and c-section delivery |
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Term
| what are risk factors for HTN in pregnancy? |
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Definition
| nulliparous women are at a higher risk for gestational HTN. older women (more likely to have chronic HTN) are at more of a risk for superimposed preeclampsia on chronic HTN. pts w/chronic HTN, multifetal gestation, african american ethnicity, or age > 35 are at more of a risk for preeclampsia. |
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Term
| what is the etiology of preeclampsia? |
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Definition
| unknown, but related to pts being pregnant for the 1st time, increased chorionic villi (twins, molar pregnancy), preexisting vascular disease, and genetic predisposition to HTN. theories: abnormal trophoblastic invasion of uterine vessels (decreased placental perfusion), immunological factors (incomplete maternal Ab response to fetal Ag = vasculitis, glomerular damage, activation of coag, and less helper T cells in 2nd trimester), inflammatory changes (endothelial injury = activated WBCs = oxidative stress), nutritional factors (ascorbic acid, antioxidants, obesity), and genetic factors (inherited thrombophilias). |
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Term
| what is the key to treating preeclampsia? |
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Definition
| early detection: early renal function, 24 hr urine, US dating (regular growth scans starting at 28 wks to ensure good blood flow/perfusion) in chronic HTN pts. also increase prenatal visits in the *3rd trimester (look for significant diastolic increase or wt gain: if present, monitor again in 3-5 days). if true HTN, significant proteinuria, visual changes, or epigastric pain occur - *hostpitalize*. |
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Term
| do pregnant chronic HTN pts w/good growth, good BP control, and good perfusion require antenatal testing? |
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Definition
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Term
| what does antepartum hospitalization for preeclampsia consist of? |
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Definition
| complete H+P (headaches, visual changes, epigastric pain, wt gain), steroids if needed for lung maturity, daily wt, check proteinuria on admission - then q 2 days, BP checks every 4 hrs, gestational HTN panel (CBC, LFTs, creatinine), frequent fetal size/AFI evaluation, reduction of physical activity, and consider delivery if appropriate (delivery will tx). |
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Term
| what is medical tx for preeclampsia/eclampsia? |
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Definition
| MgSO4 IV 2 grams/hr until 24 hrs postpartum to control/prevent seizures, intermittent antihypertensive if diastolic is over 100, avoid diuretics/hyperosmotic agents but do not limit IV fluids (diuresis will worsen proteinuria), and delivery |
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Term
| what characterizes good administration of MgSO4 for preeclampsia/eclampsia? |
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Definition
| MgSO4 has renal excretion (so monitor that), check deep tendon reflexes regularly - MgSO4 affects these first, but can freeze intercostal muscles, so monitor DTRs/respiratory function to evaluate dosage. if toxicity/respiratory depression: give calcium gluconate (then may have to intubate). |
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Term
| what are the 2 settings when antihypertensive therapy is used? what characterizes this therapy? |
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Definition
| 1) acute tx of severe HTN and 2) long term BP control. initiate tx if systolic > 160 and diastolic > 105. target BP: systolic 130-150 and diastolic 80-100. if BP too is low, it can adversely affect placental perfusion. |
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Term
| what is tx specific to acute tx of severe HTN? |
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Definition
| labetalol or hydralazine. nifedipine is OK, but nitroprusside is generally contraindicated (fetal toxicity after 4 hrs). |
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Term
| what is tx specific to long term BP control? |
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Definition
| methyldopa, labetalol/nifedipine. DO NOT USE: ace inhibitors, ARBs (can cause fetal death). loop (not thiazide) diuretics can be used if pt was previously on rx. |
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Term
| what characterizes postpartum care for pts in light of preeclampsia/eclampsia? |
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Definition
| check for resolution w/in 12 wks post partum. nulliparous pts w/preeclampsia before 30 wks or multiparous pts w/preeclampsia have an increased risk of recurrence. |
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Term
| does preeclampsia cause chronic HTN? |
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Definition
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