HTN

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Author:
rhondak
ID:
221072
Filename:
HTN
Updated:
2013-05-25 11:55:30
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OB
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Description:
Hyertension in Pregnancy
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  1. Describe the typical pattern of BP during pregnancy
    BP decreases in weeks 7 to 24, then rises to pre pregnancy norms by term
  2. Hematology
    (plasma, RBC, total blood volume)
    50% plasma increase

    450mL Red cell volume

    35% total volume increase
  3. What is mild and severe chronic HTN
    HTN present before preg or before 20 wks gestation.

    Mild SBP >140 and/or DBP >90

    Severe SBP >180 or DBP >100
  4. What is the major risk with chronic hypertension?
    Superimposed preeclampsia and eclampsia

    Look for proteinuria
  5. Treatment of chronic HTN
    Goal : ↓ stroke risk


    Methyldopa, labetolol, nifedipine.

    D/C diuretics
  6. What is the definition of gestational HTN?
    • Develops after 20 wks
    • NO PROTEINURIA
    • Returns to normal after pregnancy

    Assume it is or will become preeclampsia!
  7. Define preeclampsia..
    BP SBP >140 or DBP >90 after 20 weeks in a woman with previously normal BP

    > 300mg protein in 24 hrs
  8. What are the criteria for Severe Preeclampsia

    (ALWAYS AN INDICATION FOR DELIVERY)
    SBP >160 or DBP >110 on 2 occasions at least 6 hrs apart while patient on bedrest

    > 5g protein in 24 hrs or >3+ on two dipsticks

    <500ml urine in 24 hrs

    Cerebral or visual disturbances (HA, Scotomata)

    RUQ Pain
  9. More Severe Preeclampsia
    • hepatic dysfunction
    • thrombocytopenia
    • IUGR

    ALWAYS AND INDICATION FOR DELIVERY..
  10. What is the major pathophysiology behind preeclampsia
    MATERNAL VASOSPASM
  11. What are some risk factors for PreE
    • Nulliparous
    • Multiple gestation
    • age >35
    • Obesity
    • Af-American
    • Chronic HTN
    • Pregestational DM
  12. Whats behind the pathophysiology for PREE
    • Inadequate vascular remodeling in uterus and placenta
    • activation of coagulation cascades (larger platelets)
    • reduced plasma volume
    • glomeruloendotheliosis
  13. What is different about edema  and DTRs in PreE
    Edema is in face, hands, sacral region, or doesn't go away after lying down

    Hyperreflexia in patellar and achilles tendons especially - - ANKLE CLONUS IS BAD
  14. T/F

    Strict bedrest is proven to be the most effective treatment for severe Pre E
    False. Strict bedrest can increase risk of neonatal mortality and morbildity due to immobility
  15. MONITORING FOR PreE (4)
    2X week:

    • NST and or BPP
    • Testing for IUGR or oligohydramnios 

    US for growth and amniotic fluid Q3wks

    Daily Kick counts
  16. What is MgSO4 used for and what is the antidote



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    • Prevention of seiures related to eclampsia
    • Not an antihypertensive

    Antidote is Ca Gluconate



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  17. What is the therapeutic level of Mag
    4-6mg/dL
  18. What is the definition of H E L L P syndrome?
    • Hemolysis
    • Elevated Liver enzymes
    • Low Platelet count (usuallyl <50,000)

    Most telling sign is RUQ pain
  19. What is Eclampsia?
    Grand mal seizures not related to a neuro disorder in a patient with pre-eclampsia
  20. About what percentage of patients with gestational HTN will develop pre E later in pregnancy
    25%
  21. What is the mainstay of treatment for preeclampsia
    Rest and frequent monitoring

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