OB- HTN

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choward04
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221116
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OB- HTN
Updated:
2013-05-25 15:46:52
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OB
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  1. What is the definition of Pre-E?
    HTN with proteinuria after 20 weeks
  2. Most adverse effects of PIH are attributable to the elevated blood pressure?
    False

    **mostly due to underlying cause (vasospasm)
  3. Who is at high risk for Pre-E? (6)
    • 1. Nulliparous
    • 2. mult gestation
    • 3. AMA
    • 4. Hx of Pre-E
    • 5. Chronic HTN
    • 6. Pre-gestation DM
    • 7. AA
    • 8. obesity
    • 9. Antiphospholipid syndrome
    • 10. nephropathy/ vasculature d/o
  4. Mild Pre-E will progress to severe Pre-E before an eclamptic seizure occurs?
    False--> eclampsia effects both mild and severe
  5. What percentage of patients with GHTN will develop Pre-E later in their pregnancy?
    ~25%
  6. The mainstay of treatment for Pre-E is?
    -Rest and frequent monitoring
  7. How does MgSO4 work in Pre-E?
    • -Prevents or treats seizures
    • -Decreased smoothe muscle vasospasm, &lowering seizure threshold in brain
  8. Is MgSO4 used to treat hypertension?
    NO!  Just to treat/prevent seizures. Sometimes a side effect is lower BP because of smooth muscle relaxation
  9. What happens to the Diastolic BP in pregnancy?
    -decreases from week 7- 24 or 32, then rises to pre-pregnancy norms by term
  10. How much does the total blood volume increase to by term?
    increases 35%
  11. Define chronic HTN in pregnancy?
    HTN presenting before pregnancy or before 20 weeks.

    • Mild: >140-180 or DBP >90-100
    • Severe: >180/100
  12. 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)
  13. 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
  14. Is proteinuria seen with GHTN?
    NO

    • **30% of mult gestation will develop GHTN
    • **BP returns to normal after pregnancy
  15. What is the definition of Pre-E?
    BP >140/90 after 20 weeks gestation with previously normal BP AND >300mg protein in 24hr urine
  16. What is the definition of severe Pre-E?
    -BP >160/110 on 2 separate occassions 6 5hrs apart while patient is on bedrest

    And/or

    ->5g protein in 24hr  or 3+ on 2 separate dipsticks

    AND combination of below

    • -visual changes, H/A, Pulm edema
    • -epigastric pain
    • -evidence of hepatic dysfunction
    • -thrombocytopenia
    • -IUGR
  17. T or F.  Severe pre-E is always and indication to deliver.
    True
  18. What are some possible causes of Pre-E?
    • 1. Immunologic problems (sperm theory)
    • 2. Age extremes
    • 3. Genetic predisposition
  19. What is the main issue causing problems in Pre-eclamptic women?
    Maternal vasospam
  20. 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
  21. 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
    • -Epigastric pain
    • -Hyperreflexia
    • -COnstriciton of retinal vessels (fundoscopic exam)
  22. 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)
  23. What are some fetal complications from Pre-E?
    • 1. IUGR
    • 2. Increase mortality
    • 3. Placental abruption
    • 4. Inadaquate perfusion, non-reassuring FHTs during labor
  24. What often should fetal growth and AFI be tested for Pre-E?
    every 3 weeks
  25. How often should an NST and BPP be performed?
    Twice weekly
  26. How often should IUGR or oligohydramnios be tested
    twice weekly
  27. 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
  28. What is the antidote for magnesium?
    slow calcium gluconate push
  29. What should you monitor when a patient is on continuous MgSO4?
    • -patellar reflex
    • -respirations
    • -urine output
  30. What is the therapeutic level for MgSO4 for Pre-eclampsia?
    Serum--> 4-6
  31. 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
  32. When are anti-hypertensive used in Pre-E?  What is the goal?
    BP >160/105

    Goal--> slow decrease to DBP 90-100.  Don't want to drop quickly or may decrease perfusion to placenta
  33. When should labetalol NOT be given?
    -asthma, heart failure, placental insufficiency--> may cause fetal brady
  34. What BP meds are best for Pre-E?
    • -Methyldopa or nifedapine (ca+ channel blocker)
    • -Labetolol and hydraline (esp in labor)
  35. How long should mg be continued after delivery?
    24hrs
  36. Define HELLP syndrome.
    • Hemolysis
    • Elevated liver enzymes
    • Low Platelets

    **indication for delivery
  37. When is the greatest risk for an eclamptic seizure to occur?
    -within 24hrs of delivery
  38. What are risk of eclampsia?
    • 1. injury
    • 2. hypoxia
    • 3. aspiration
    • 4. status epilepticus
    • 5. danger to fetus if uterine hyperactivity >20min
  39. What is the treatment for eclampsia?
    • -watch for maternal physical safety
    • -maintain airway/O2
    • -Make IV access
    • -Initiate MgSO4 (IM/IV)
    • -ABGs
    • -Foley
    • -Consider central line/EKG

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