Term
| what is hypertension defined as 2 |
|
Definition
>140/90 on two occasions at least 6h apart
15mm rise in diastolic or 30 mm rise in systolic over previous reading |
|
|
Term
| what is the proper position for checking BP |
|
Definition
lowest in supine lateral
medium in sitting
highest in standing |
|
|
Term
| how should a cuff be sized to take BP |
|
Definition
| length 1.5xUE or cuff with bladder that covers 80* ue |
|
|
Term
| explain how to take a blood pressure the diagnoses gesational diabetes |
|
Definition
rest for 10 min supine
take BP seated
should decrease in second trimester |
|
|
Term
| how prevelant is pregnancy induced HTN |
|
Definition
| 5-10% of pregnancies and 30% of multiples |
|
|
Term
| how can maternal morbidity risk be determined when patient has HTN 2 |
|
Definition
srverity and duration of HTN
prenatal mortality increases with each 5mm increase in MAP |
|
|
Term
| what are the 6 types of HTN with pregnancy |
|
Definition
pregnancy induced HTN (Gestational HTN)
CHTN preceeding pregnancy (any etiology
CHTN (any etiology) with pregnancy induced HTN on top
chtn with superimposed preeclampsia
CHTN with superimposed eclapmsia
transient HTN of pregnancy (gestational HTN) |
|
|
Term
| what are the 2 types of gestational HTN |
|
Definition
preclampsia: HTN with proteinuria (+/-edema) induced by pregnancy after 20 WEEKS OF GESTATION
eclampsia: convulsions without other neurological diseases |
|
|
Term
| define CHTN preceding pregnancy |
|
Definition
| present before twentieth week gestation or beyond 6 wks post partum |
|
|
Term
| define ChTN wth superimposed preeclampsia |
|
Definition
| develpment of preeclampsia in patient with pre existing HTN |
|
|
Term
| define transient HTN of pregnancy (gestational HTN) |
|
Definition
| development of HTN in late pregnancy in absence of other findings suggestive of preeclampsia |
|
|
Term
| risk factors for preeclampsia 12 |
|
Definition
primiparas
multifetal gestation
preeclampsia in previous pregnancy
pregestation diabetes
vascular disease
renal disease (neuropathy)
CT disorder
antiphospholipid antibody syndrome
obesity
35yo+
african american
chronic HTN |
|
|
Term
| diagnosis of preeclampsia: must have 1 of the following 10 |
|
Definition
>160/110 on 2 occasions 6h apart while on bed rest
proteinuria >5G IN 24H!
oliguria: <500mL in 24h
cerebral or visual disturbance
pulmonary edema or cyanosis
epigastric or right upper quadrant pain
impaired liver function
thrombocytopenia
fetal growth
restriction/oligohydraminos |
|
|
Term
|
Definition
abnormal trophoblastic invasion in uterine spiral arteries
immunologic intolerance between maternal and fetaoplacental tissue
maternal maladaptation to cardiovascular or inflammatory changes of normal pregnancy (vascular changes)
dietary deficiencies (Ca/Mg)
genetic influences |
|
|
Term
| which cause of preeclampsia is required |
|
Definition
| abnormal trophoblastic invasion of uterine spiral arteries |
|
|
Term
| how does abnormal trophoblastic invasion of uterine spiral arteries change the body causing preeclapmsi |
|
Definition
dilates low resistance spiral arteries to become vasoconstricted increasing BP
hemoconcentration: capillaries become leaky and cause edema in hands and face and protein in urine Hb increases in concentration abd urea increases due to decreased GFR
change in vessel reaxction to prostaglandin
resistance to ANG II causes BP and TPR increase |
|
|
Term
| what is the basic underlying culprit to preeclamopsia why |
|
Definition
vasospasm causes HTN, seizure, drop in urinary output, abruption, liver ischemia
increase in vasoactive agents causes spasm (prostacylin (dilate)
thronboxae A1(constrict)
NO (dilates) decreased
endothelials (constrict) increased |
|
|
Term
| what are the hematologic changes that occur in preeclapmsia 4 |
|
Definition
thrombocytopenia/DIC
hemolysis
increased HCT
increased lactate DH |
|
|
Term
| what hemagolotic change is a sign of hemolysis |
|
Definition
| lactete dehydrogenase (present inside RBC) |
|
|
Term
| what hepatic changes are associated with preeclampsia 4 |
|
Definition
associated with worsening preeclampsia
abnormal liver studies: AST/ALT
hyperbilirubinemia
hepatic hemorrhage (subscapular hematoma or rupture) |
|
|
Term
| what neurological changes occur with preeclampsia 6 |
|
Definition
headache
blurred vision
scotomata
hyperreflexia
intracranial hemorrhage
temporary blindness (amaurosis) |
|
|
Term
| fetal changes in preeclampsia 9 |
|
Definition
decreased uteroplacental blood flow due to vasospasm
placental infarction
IUGR
placental abruption
non-reassuring fetal status
placenta aize and function decreased due to vasospasms causing fetal hypoxia, malnutrition, IUGR, oligohydraminos, dysmaturity |
|
|
Term
| what are 4 signs of non-reassuring fetal status |
|
Definition
|
|
Term
| how do you evaluate for preeclampsia 9 |
|
Definition
history and physical
visual disturbances
headache
R upper quadrant pain
weight >2kg/wk
peripherial edema (esp hands and face)
blood pressure: sitting and supine
fundoscopic exam: vasoconstriction of retinal vessels
DTR: hyperreflex and clonus worrysome |
|
|
Term
| what causes right upper quadrant pain |
|
Definition
| tender liver due to hepatic capsule distension 9gleasons capsule) |
|
|
Term
| what labs fo you get for preeclamsia 10 |
|
Definition
uric acid (>4.5)
serum creatinine
CBC and platelets
coagulation profile (PTT/PT), fibrinogen, fibrin split products
liver function test (AST/ALT)
LDH
24h urine protein |
|
|
Term
| what forms of fetal survalence should be used in a baby whos mom has preeclampsia 4 |
|
Definition
ultrasound (growth, doppler blood flow, AFI)
NST
BPP
OCT |
|
|
Term
| what is the treatment and prevention of preeclampsia |
|
Definition
no known prevention, only cure is delivery
regression rate of BP is unperdictable after delivery |
|
|
Term
| how is preeclampsia damaged, when do you deliver |
|
Definition
determined by severity and maturity of fetus
deliver >37wks and are just diagnosed
if severe deliver at 34wks and progress worsens
if diagnose is made prior to term in hospitalization to assess extent of disease
bed rest
lab evals: LFTs, protein, uric acid
steroids for maturity if <34wks to mature lungs
fetal surveillance
BP control: methyldopa, labetalol
CNS exams
control BP
monitor urine output |
|
|
Term
| what is given in severe preclampsia and eclaposia to prevent seizure, se |
|
Definition
| Mg sulfate, lowers BP, diarrhea |
|
|
Term
| how is BP controlled in preeclampsia |
|
Definition
| diastolic >110 need to decrease SLOWLY to protect fetus (maintain 90-100) (LABETALOL, HYDRALAZINE, METHALDOPA MOST COMMON) |
|
|
Term
| what is the route of delivery for preeclampsia baby |
|
Definition
induction for vaginal delivery
C section for obsterical indication or worsening condition of mother or fetus |
|
|
Term
| what is the normal concentration of Mg |
|
Definition
|
|
Term
| what are the toxic effects of Mg at 4-7, 8-12, 9-12, 15-17, >30 mg/dL |
|
Definition
4-7: theraputic level
8-12: ECG changes, loss of patellar reflex
9-12: feeling of warmpth, flushing
15-17: somnolence, slurred speech, muscle paralysis, respiratory difficulty
>30 cardiac arrest |
|
|
Term
|
Definition
protect mom from harm
start IV Mg sulfate, O2, lower BP
usually self limiting, not fangerous to fetus unless >10min
anti-zeisure meds, diazepam, pnenobarbitol
EKG: ABGs
NEVER DELIVER DURING SEIZURE, END SEIZURE AND DELIVER IMMEDIATLY IF HAS BEEN SEIZING FOR >10 MIN |
|
|
Term
| what does HELP syndrome stand for |
|
Definition
| hemolysis elevated liver enzymes and low platelets |
|
|
Term
|
Definition
| progressive form of severe preeclampsia (may bw with or without big BP increase) |
|
|
Term
| symptoms of help syndrome |
|
Definition
| nausea, vomiting, nonspecific flu like symptoms, RUQ pain, headache, visual changes, bleeding jaundice, shoulder or neck pain, diarrhea, DIC |
|
|
Term
| when does someone with help syndrome need a platelet transfusion, why do they need it |
|
Definition
<20000
<50000 04 75000 if C/S
lower platelets = higher mom and baby mortality |
|
|
Term
| what are the 3 ways help syndrome is diagnosed |
|
Definition
hemolysis
elevated liver enzymes
low platelets <1000,000 |
|
|
Term
| what are the levels of liver enzymes that signify help syndrome |
|
Definition
|
|
Term
| what are the levels of LDH, bilirubin in blood indicating help syndrome |
|
Definition
LDH >600 u/L
serum total bilirubin >1.2 mg/dL |
|
|
Term
| how do you stabilized the mom in help syndrome 5 |
|
Definition
treat severe HTN
correct coagulopathy if DIC present
seizure prophylaxis with MgSO4
CT/US if liver hematoma suspected
transfer to perinatal center |
|
|
Term
| how do you correct coagulpaphy if DIC present in help syndrome |
|
Definition
platelets
fresh frozen plasma |
|
|
Term
| how do you tx severe HTN in help syndrome |
|
Definition
>160/110
IV hydralazine DOC 1st line
IV/PO labetalol DOC 1st line
PO nifepidine
IV nutroprusside/nitroglucerin |
|
|
Term
| how do you assess the fetus in help syndrome |
|
Definition
non-stress
amniotic fluid index
biophysical profile
ultrasonography
biometry
umbilical artery doppler: no evidence of value norms
delivery based on likleihood of lung maturity |
|
|
Term
| what do you do if a baby with help syndrome's lungs are immature and mom is seizing and it is time to deliver |
|
Definition
| glucocorticoids, wait 48h |
|
|
Term
| how do you decide which way to deliver help syndrome baby |
|
Definition
vaginal: PGE for cervical ripening, oxytocin for labor induction or augmentation
C section: maternal or fetal jeporady, unripe cervix <30 weeks, esp if abnormal doppler studies |
|
|
Term
| how is help syndrome prevented 3 |
|
Definition
low dose aspirin
Ca supplements
antioxidant therapy: Vit C 1000mg/d, vit E 100u/d) |
|
|
Term
| what is the definition of chronic HTN in pregnancy |
|
Definition
HTN before 20th week or present before pregnancy
>140/90 mild, >180/90 severe |
|
|
Term
| how do you treat if mom has mild HTN in pregnancy |
|
Definition
no improvement in fetal outcome with tx
methyldopa/laberelol if you insist |
|
|
Term
| what is the normal trend of BP in pregnancy |
|
Definition
| 1st trimester (16-20 wks) raises to pregestational level |
|
|
Term
| effects of HTN on pregnancy 5 |
|
Definition
preterm birth
IUGR
fetal demise
abruption
superimposed preeclempsia |
|
|
Term
| evaluation of HTN in pregnancy |
|
Definition
evaluate prior to conception
EKG, ECHO, eye exam, renal ultrasound
current LVH could decompensate
renal functions: BUN/CR, 24h protein, CR clearance
liver function tests
CB uric acid |
|
|
Term
| what BP meds are good in pregnancy 2, any SE |
|
Definition
methyldopa: limited effect on utroplacental flow
labetalol: A and B blocker |
|
|
Term
| what meds are BAD in pregnancy 3, why |
|
Definition
B blocker: increase SGA
CCV: uteroplacental perfusion reduction
ACEI: contraindicated in 2nd and 3rd trimester, teratogenic |
|
|
Term
| what does ACEI do to babies 6 |
|
Definition
calvarial bone underdevelopment
renal failure
IUGR
renal dysgenesis
pulmonary hypoplasia
fetal and neonatal death |
|
|
Term
| what modes of fetal survalence should you do in maternal HTn 7 |
|
Definition
serial us for growth
doppler flow studies
NST
AFI
BPP as needed
delivery can proceed to term fiven normal fetal growth and placental perfusion, if growth restricted one can aim froom maturity and delivery |
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