Card Set Information
What is the definition of Pre-E?
HTN with proteinuria after 20 weeks
Most adverse effects of PIH are attributable to the elevated blood pressure?
**mostly due to underlying cause (vasospasm)
Who is at high risk for Pre-E? (6)
2. mult gestation
4. Hx of Pre-E
5. Chronic HTN
6. Pre-gestation DM
9. Antiphospholipid syndrome
10. nephropathy/ vasculature d/o
Mild Pre-E will progress to severe Pre-E before an eclamptic seizure occurs?
False--> eclampsia effects both mild and severe
What percentage of patients with GHTN will develop Pre-E later in their pregnancy?
The mainstay of treatment for Pre-E is?
-Rest and frequent monitoring
How does MgSO4 work in Pre-E?
-Prevents or treats seizures
-Decreased smoothe muscle vasospasm, &lowering seizure threshold in brain
Is MgSO4 used to treat hypertension?
NO! Just to treat/prevent seizures. Sometimes a side effect is lower BP because of smooth muscle relaxation
What happens to the Diastolic BP in pregnancy?
-decreases from week 7- 24 or 32, then rises to pre-pregnancy norms by term
How much does the total blood volume increase to by term?
Define chronic HTN in pregnancy?
HTN presenting before pregnancy or before 20 weeks.
: >140-180 or DBP >90-100
How do you differenciate worsening chronic HTN from super-imposed Pre- E?
-Look for worsening HTN WITH proteinuria and other symptoms of Pre-E (floaters, H/As, epigastric pain)
What is the recommended pharm treatment for Chronic HTN in pregnancy?
-Don't usually start BP meds unless > 150-160/100-110
-If already on meds, may consider discotinueing or decreasing dose until BP become severe
**Methyldopa, labetolol, nifedapin
**NO ACE in 2nd/3rd Tri
If already on diuretics or has severe BP, diuretics may be an option
Is proteinuria seen with GHTN?
**30% of mult gestation will develop GHTN
**BP returns to normal after pregnancy
What is the definition of Pre-E?
BP >140/90 after 20 weeks gestation with previously normal BP AND >300mg protein in 24hr urine
What is the definition of severe Pre-E?
-BP >160/110 on 2 separate occassions 6 5hrs apart while patient is on bedrest
->5g protein in 24hr or 3+ on 2 separate dipsticks
AND combination of below
-visual changes, H/A, Pulm edema
-evidence of hepatic dysfunction
T or F. Severe pre-E is always and indication to deliver.
What are some possible causes of Pre-E?
1. Immunologic problems (sperm theory)
2. Age extremes
3. Genetic predisposition
What is the main issue causing problems in Pre-eclamptic women?
Besides vasospasm, what are other patho findings during Pre-E?
1. Vascular remodeling in uterus/placenta
2. Activation of coagulation cascades
3. Decreased plasma volume
4. Enlarged gomerulus
5. oxidative stress
6. Endothelial injury
What are some S/S of disease to watch out for?
-Edema (outside of LE)
-Visual changes or floaters
-Severe H/A unrelieved w/ pain meds
-COnstriciton of retinal vessels (fundoscopic exam)
What lab studies are needed for mom and testing for fetus for Pre-E?
Labs--> CBC, platelet, LFTs, serum creatinine, 2hr urine (protein)
Fetal--> frequent monitoring for wt, growth, AFI, NST (BPP later in pregnancy)
What are some fetal complications from Pre-E?
2. Increase mortality
3. Placental abruption
4. Inadaquate perfusion, non-reassuring FHTs during labor
What often should fetal growth and AFI be tested for Pre-E?
every 3 weeks
How often should an NST and BPP be performed?
How often should IUGR or oligohydramnios be tested
What is the treatment for Pre-E?
-Maybe hospitalize initially to see if worsens, if mild, can be sent home with rest and frequent monitoring
-If severe-- MgSo4, BP meds as needed, close monitoring of mom/fetus, delivery as needed
What is the antidote for magnesium?
slow calcium gluconate push
What should you monitor when a patient is on continuous MgSO4?
What is the therapeutic level for MgSO4 for Pre-eclampsia?
When are EKG changes seen and when are patellar reflexes lost? (what serum Mg level)?
-EKG changes can occur w/ level at 5-10
-Patellar reflexes are lost between 8-10
**if these symptoms occur, Mg must immediately be stopped, consider Ca gluconate is symptoms severe or respiratory depression occurs
When are anti-hypertensive used in Pre-E? What is the goal?
Goal--> slow decrease to DBP 90-100. Don't want to drop quickly or may decrease perfusion to placenta
When should labetalol NOT be given?
-asthma, heart failure, placental insufficiency--> may cause fetal brady
What BP meds are best for Pre-E?
-Methyldopa or nifedapine (ca+ channel blocker)
-Labetolol and hydraline (esp in labor)
How long should mg be continued after delivery?
Define HELLP syndrome.
Elevated liver enzymes
**indication for delivery
When is the greatest risk for an eclamptic seizure to occur?
-within 24hrs of delivery
What are risk of eclampsia?
4. status epilepticus
5. danger to fetus if uterine hyperactivity >20min
What is the treatment for eclampsia?
-watch for maternal physical safety
-Make IV access
-Initiate MgSO4 (IM/IV)
-Consider central line/EKG