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Describe the typical pattern of BP during pregnancy
BP decreases in weeks 7 to 24, then rises to pre pregnancy norms by term
(plasma, RBC, total blood volume)
50% plasma increase
450mL Red cell volume
35% total volume increase
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
What is the major risk with chronic hypertension?
Superimposed preeclampsia and eclampsia
Look for proteinuria
Treatment of chronic HTN
Goal : ↓ stroke risk
Methyldopa, labetolol, nifedipine.
What is the definition of gestational HTN?
- Develops after 20 wks
- NO PROTEINURIAReturns to normal after pregnancy
Assume it is or will become preeclampsia!
BP SBP >140 or DBP >90 after 20 weeks in a woman with previously normal BP
> 300mg protein in 24 hrs
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)
More Severe Preeclampsia
- hepatic dysfunction
ALWAYS AND INDICATION FOR DELIVERY..
What is the major pathophysiology behind preeclampsia
What are some risk factors for PreE
- Multiple gestation
- age >35
- Chronic HTN
- Pregestational DM
Whats behind the pathophysiology for PREE
- Inadequate vascular remodeling in uterus and placenta
- activation of coagulation cascades (larger platelets)
- reduced plasma volume
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
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
MONITORING FOR PreE (4)
- NST and or BPP
- Testing for IUGR or oligohydramnios
for growth and amniotic fluid Q3wks
Daily Kick counts
What is MgSO4 used for and what is the antidote
- Prevention of seiures related to eclampsia
- Not an antihypertensive
Antidote is Ca Gluconate
What is the therapeutic level of Mag
What is the definition of H E L L P syndrome?
- Elevated Liver enzymes
- Low Platelet count (usuallyl <50,000)
Most telling sign is RUQ pain
What is Eclampsia?
Grand mal seizures not related to a neuro disorder in a patient with pre-eclampsia
About what percentage of patients with gestational HTN will develop pre E later in pregnancy
What is the mainstay of treatment for preeclampsia
Rest and frequent monitoring
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