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20 Cards in this Set
- Front
- Back
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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 |
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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)
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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 |
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Why is HTN during pregnancy a concern? |
a leading cause of maternal & fetal morbidity, thromboembolism, hemorrhage, & nonobstretric injuries |
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________ is the result of reduced organ perfusion during pregnancy. |
Pre-eclampsia |
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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 |
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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) |
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Reduction in GFR & renal blood flow damages the glomerular membrane & leads to _____________ associated w/ pre-eclampsia |
proteinuria |
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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) |
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When severe pre-eclampsia causes (4 things) you should consider immediate delivery |
-retinal vasospasm -visual disturbances = cerebral vasospasm -hyperreflexia = 3+ DTRs -clonus = neuromuscular irritability |
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What is HELLP syndrome?
why is it dangerous? |
-variant of severe pre-eclampsia Hemolysis Elevated Liver enzymes Low Platelets
leads to rapid deterioration!!! |
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What are the risk factors for HELLP syndrome? |
multiparous (multiple births) woman > 25 yrs old > 36 weeks gestation HTN |
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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) |
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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) |
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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 |
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Fetal indications for delivery in pre-eclampsia |
-severe fetal growth restrictions -nonreassuring fetal test results -oligohydramnios |
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When does pre-eclampsia become eclampsia? |
when tonic-clonic seizures develop in pregnant female w/ no prior seizure hx |
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Prodromal sx of Eclampsia |
severe headaches sustained clonus Chvostek's sign |
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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***) |
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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 |
