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35 Cards in this Set

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What do you always ask about in pre-eclampsia?

1. Headache


2. Epigastric pain


3. Visual disturbances

Define Gestational Hypertension

Sustained Increased BP, no proteinuria in Gestation > 20 wks

Gestational Hypertension normalizes by 12 weeks postpartum. Retrospectively, this is called?

If it doesn't normalize, we call it?

Transient HTN

Chronic HTN

Patient history

Swelling of hands and feet, denies Headache, epigastric pain or visual changes.
Gained 10 ibs over 2 weeks. BP 155/95 consistently. 2+ protein on urine

History (due to protein in urine, mild weightgain and HTN) is consistent with
Mild Preeclampsia

Mild preeclapsia triad is?

Gestation > 20 wks




Sustained HTN > 14/90

Proteinuria >300 mg/24 hr

Two demographic risk factors for PreEclampsia?

1. Nullipara

2. Age extremes, <20 and >34 yrs

Three Obstetric risk factors for PreEclampsia?

1. Multiple gestation




2. Molar pregnancy




3. Non-immune hydrps

Four Medical risk factors for PreEclampsia?

What ties these four conditions together?

1. DM




2. Chronic HTN




3. Renal disease




4. SLE

Small vessel disease

Pathophys for Mild preeclampsia?

Diffuse vasospasm, capillary injury

Patient management in Mild PreEclampsia when patient is > 36 wk?

What manner of delivery is optimal?

MgSO4 (to prevent convulsions) + delivery

Vaginal delivery

What is the mechanism of PreEclampsia?

Prostaglandins are involved!


Increased Thromboxane (vasoconstrictor)




Decreased Prostacycline (vasodilator)

Patient history

21, G1 32 wks confirmed by 1st trim USG

Severe occipital Headache, mid-epigastric pain and light flashes. Gained 10 ibs in 2 wks, BP 165/115. 3+ pedal edema, fingers are swollen.
Urine dipstick 4+ protein!

Whaaat is it?

Severe PreEclampsia

What is the BP level differentiating Mild from Severe PreEclampsia?

>/ 160/110 is Severe

Mild hypertension, mild proteinuria in addition to any of the following:
1. DIC
2. Increased liver enzymes
3. Pulmonary edema


4. Oligura


5. Cyanosis

..points to which diagnosis?

Sever end organ involvement, SEVERE PreEclampsia

Discovery of a Schistocyte in a pregnant woman, will point to which diagnosis?

DIC, which again points to SEVERE PreEclampsia

Aggressive management of Severe PreEclampsia includes?

IV MgSO4 --> prevent convulsions
Continue 24 hrs postpartum

Lower BP --> use Hydralazine or Labetalol

Induce labor --> if mom & fetus are stable
IV oxytocin & amniotomy

Which compound is given to a baby for lung maturation?

Bethamethasone

Why give a baby Betamethasone?

To mature the lungs

Patient History
21-yr old G1 w generalized tonic-clonic seizure at 32 wks.
Seizure was preceded by a severe Headache.
Gained 10 ibs in 2 wks. Unresponsive in a postictal state. BP is 185/115, urine dipstick 4+ protein.

Whaaat is it?

Eclampsia

(BP and urine protein doesn't have to be high, as long as it's accompanied by seizures)

Pathophysiology of Eclampsia?

Cerebral vasospasm, ischemia & brain edema

Symptoms of Eclampsia?

Tonic-clonic Seizures

Lab findings in Eclampsia

Hemoconcentration, increased liver enzymes and evidence of DIC

Management of Eclampsia?

1. Stop convulsions with MgSO4 (continue for 24 hrs postpartum)




2. Prompt delivery at any gestational age to save the mother




3. Lower diastolic BP to 90-100 mm/Hg

Diagnosis of Chronic HTN in pregnancy?

Gest <20 wks or pre pregnancy

Sustained HTN >140/90

+/- proteinuria

3 Factors signifying poor prognosis in Chronic HTN


Kidneys: Renal disease
Creatinine > 1,4mg/dL

Eyes: Retinopathy
Hemorrhages, exudates, narrowing




Heart: LVH
Prolonged BP >180/110

What signifies the worst prognosis in Chronic HTN?

What may these patients suffer?

Uncontrolled HTN: 250/140

or

Chronic HTN + superimposed PIH/PreEclampsia

Intracerebral Hemorrhage

How to diagnose Chronic HTN w/ superimposed PIH?

Chronic HTN

Worsening BP

Worsening proteinuria

Which HTN medication should never be used in pregnancy?

1. ACE inhibitors (fetal renal failure)




2. Diuretics (decrease fetal profusion)

Management in Chronic HTN & superimposed PIH/PreEclampsia?

1. IV MgSO4




2. Lower BP --> dias 90-100 mm Hg
( use Hydralazine or Labetalol)




3. Induce labor - if mom & fetus stable. Regardless of gestational age


IV oxytocin & amniotomy

HELLP syndrome abreviation?

Subclassification of which condition?

Hemolysis
Elevated Liver Enzymes
Low Platelets

Subclassification of PreEclampsia

Patient history

32 yr-old multigravida at 32 wks
BP 160/105. Previous BP normal.
Increased total bilirubin, LDH, ALT, AST + PLT count of 85,000. No HA or visual changes

Which condition?

HELLP Syndrome

Increased total bilirubin is evidence of hemolysis
Platelets should be 150K

Management of HELLP? (like all the others...)

+++ one more thing!

IV MgSO4 - prevent convulsions

Induce labor - if mom & fetus stable
IV oxytocin & amniotomy

Lower BP - dias 90-100 mm Hg
Use Hydralazine or Labetalol


+++ give Maternal steroids - Dexamethazone

Which HTN related condition has the highest incidence of abruptio placenta?

HELLP syndrome

If Chronic HTN is uncomplicated during pregnancy, which antihypertensive drug can be used to treat the mother?

Alpha Methyl-Dopa

Eclampsia prior to 20 wk gestation is rare and should raise the possibility of an underlying _____ or ___________ syndrome

Molar Pregnancy

Antiphospholipid Syndrome