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20 Cards in this Set

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22 yr old pregnant female presents w/ new onset hypertension at 23 wks gestation. She complains of persistant headache, epigastric discomfort, occasional blurry vision. PE reveals brisk deep tendon reflex.


2 most likely dx?


what can differentiate btwn the 2?

Gestational (transient) HTN or pre-eclampsia



urine sample to check for proteinuria.



if proteinuria (> 300mg) = pre-eclampsia

If a pregnant women presents w hypertension early on in pregnancy (before 20 wks). What is the likely dx?

Chronic HTN



(= HTN diagnosed PRIOR to pregnancy or persisting > 12 wks postpartum)


Chronic HTN w/ new onset proteinuria after 20 wks of gestation is considered ___________



Is this more/less dangerous than pre-eclampsia?

Chronic HTN w/ Superimposed pre-eclampsia



more- worse prognosis than chronic HTN or pre-eclampsia alone

Why is HTN during pregnancy a concern?

a leading cause of maternal & fetal morbidity, thromboembolism, hemorrhage, & nonobstretric injuries

________ is the result of reduced organ perfusion during pregnancy.

Pre-eclampsia

Pre-eclampsia triad:

1. HTN (BP > 140/90) after 20 wks. in pt w/ previously normal BP


2. Proteinuria (in latter half of pregnancy)


3. Rapid weight gain/edema

What are the risk factors for Pre-eclampsia

-history of HTN


-age < 18 or > 35


-obesity prior to pregnancy


-hx of diabetes, lupus, renal disease


-carrying twins (multiple fetus= bigger placenta)


-black women


-primigravida (1st pregnancy)

Reduction in GFR & renal blood flow damages the glomerular membrane & leads to _____________ associated w/ pre-eclampsia

proteinuria

Rapid weight gain


Elevated BP > 140/90


Proteinuria (> 300), +1 urine


Headache of new onset


Increasing edema


.........are all assoc. w/ mild pre-eclampsia.



When does it become severe pre-eclampsia?

Severe pre-eclampsia:


BP > 160/110


proteinurea > 5gm, 3+ urine


oliguria (decr urination, < 400 mL)


pulmonary edema


epigastric pain (liver stretching)

When severe pre-eclampsia causes (4 things) you should consider immediate delivery

-retinal vasospasm


-visual disturbances = cerebral vasospasm


-hyperreflexia = 3+ DTRs


-clonus = neuromuscular irritability

What is HELLP syndrome?



why is it dangerous?

-variant of severe pre-eclampsia


Hemolysis


Elevated Liver enzymes


Low Platelets



leads to rapid deterioration!!!

What are the risk factors for HELLP syndrome?

multiparous (multiple births)


woman > 25 yrs old


> 36 weeks gestation


HTN

How do you tx pre-eclampsia?

mild:


bed rest


frequent monitoring


delivery (only cure)*


methyldopa (only if necessary for HTN)



severe:


hospitalization


IV Hydralazine (or labetalol for HTN)

T/F


When tx HTN in pre-eclampsia, you should NOT lower BP much less than 140/90

TRUE



(may result in decreased uteroplacental blood flow & fetal demise)

Maternal indications for delivery in pre-eclampsia

-gestational age 38 wks


-platelet count < 100,000 cells/mm^3


-progressive liver & renal deterioration


-abruptio placentae


-persistent headaches, visual changes, nausea, epigastric pain or vomitting

Fetal indications for delivery in pre-eclampsia

-severe fetal growth restrictions


-nonreassuring fetal test results


-oligohydramnios

When does pre-eclampsia become eclampsia?

when tonic-clonic seizures develop in pregnant female w/ no prior seizure hx

Prodromal sx of Eclampsia

severe headaches


sustained clonus


Chvostek's sign

What is the tx for eclampsia seizures (& seizure prophylaxis in pre-eclampsia)?

Parenteral magnesium sulfate



(^use caution on pts w renal failure, monitor DTR's, respiration, & urinary output)



(once hypoxia, convulsions, & BP stablilized--> deliver baby vaginally***)

What other anti-convuslants can be used (not as safe)?

Phenytoin- must do cardiac monitoring, may cause hypotension & bradycardia



Valium- may cause CNS depression in fetus