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53 Cards in this Set

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what are 4 of the leading causes of maternal mortality?
HTN
thromboembolism
hemorrhage
nonbstetric injuries
what are the 4 categories in hypertension in pregnancy?
chronic
preeclampsia/eclampsia
preeclampsia superimposed on chronic
gestational/transient HTN
what is chronic HTN?
BP >140/90 prior to pregnancy or 20 weeks gestation
what does diagnosis of chronic HTN require? (3)
known HTN prior to pregnancy
HTN prior to 20 weeks gestation
presenting HTN>12 weeks postpartum
what is the definition of preeclampsia?
reduced organ perfusion related to vasospasm and activation of the coagulation cascade
when does preeclampsia occur?
after 20 weeks gestation
what is the triad of pre-eclampsia?
HTN after 20 weeks in a previously normotensive pt
proteinuria
weight gain/edema
what are 6 risk factors of preeclampsia?
history of HTN, diabetes, lupus, renal disease
extremes in maternal age
obestiy prior to pregnancy
carrying more than one fetus
african american
primigravida
what is preeclampsia a disorder of?
endothelial function with associated vasospasm
what is the definitive cure of preeclampsia?
delivery of the PLACENTA
what damage does preeclampsia cause and what does this lead to?
damage of the glomerular membranes
which increases permeability to proteins -->proteinuria
when is it most common to get preeclampsia?
3rd trimester
what should you look for in patients presenting with HTN before the 3rd trimester? (2)
gestational trophblastic disease
molar pregnancy
what are 2 main symptoms of preeclampsia?
BP>140/90
proteinuria
what are 4 other symptoms of preeclampsia?
rapid weight gain
rapid edema
new onset headache
epigastric pain
what are 3 additional symptoms of severe preeclampsia?
oliguria
pulmonary edema
epigastric of RUQ pain
what is the difference between mild and severe preeclampsia in BP reading?
mild = 140/90
severe = 160/110
what is the difference between mild and severe preeclampsia in proteinuria?
mild = 300mg
severe = 5gms
what is a severe manifestation of preeclampsia and one in which you should consider delivery?
retinal vasospasm
what preeclampsia signs are thought to be due to cerebral vasospasm?
scintillations
scotomata
what are 2 neuromuscular signs of severe preeclampsia?
hyperreflexevia +3 DTRs
clonus
when should you be concerned about severe preeclampsia? (7)
BP >160/110
heavy proteinuria
oliguria
cerebral/visual disturbances
epigastric/RUQ pain
impaired liver function
thrombocytopenia
what is the HELLP syndrome?
Hemolysis
elevated liver enzymes
low platelets
what are 2 signs of hemolysis in pregnancy?
abnormal blood smear
elevated bilirubin
what are 2 signs of elevated liver enzymes in pregnancy?
SGOT >72
LDH >600
what is considered a low platelet level in pregnancy?
<100,000
what are 4 risk factors for the HELLP syndrome?
multiparous
>25 yo
>36 weeks gestation
mild to severe HTN
what should you do in a preeclampsia workup? (7)
hematocrit/hemoglobin
platelet count
serum uric acid
transaminase levels
coagulation profile
UA
US
what defines eclampsia?
presence of seizures (tonic-clonic)
true obstetrical emergency
how do you treat eclampsia palliatively? (3)
close observation
serial US exams
bedrest
what may exacerbate pathologic changes in preeclampsia?
attempts to treat preeclampsia by diuresis or lowering BP
who is hospitalization recommended for? (2)
new onset preeclampsia
preterm onset of severe preeclampsia
what is the goal BP for mild preeclampsia?
140/90
what are 3 safe drugs for reducing BP in pregnancy?
methyldopa
calcium channel blockers
labetalol
what category is methyldopa?
B
what are 5 maternal indications for delivery in preeclampsia?
gestation age of 38 weeks
platelet count <100,000
progressive deteriorating liver and renal function
suspected abruptio placentae
persistent headaches, visual changes, nausea, epigastric pain
what are 3 fetal indications for delivery in preeclampsia?
severe growth restriction
nonreassuring test results
oligohydramnios
what is most commonly used to treat severe preeclampsia?
parenteral hydralazine
what is a second line drug in severe preeclampsia?
labetalol
who should avoid labetolol?
women with asthma and CHF
what should you be very careful with in lowering Bp and why?
it may result in uteroplacental blood flow and fetal demise
what category drug is magnesium sulfate?
A
what are 3 prodromal symptoms of eclampsia?
severe headaches
sustained clonus
chvostek's sign
what is a seizure prophylaxis?
parenteral magnesium sulfate
what is an added benefit of magnesium sulfate?
increases uterine blood flow to the fetus
why do you need to monitor patients closely who took magnesium sulfate? (4)
decreases DTRs, respiration, urinary output, and BP
what are 2 category D drugs that may be used to treat seizures?
phenytoin
valium
what carries a worse prognosis than chronic HTN or preeclampsia alone?
chronic HTN superimposed on preeclampsia
what is the criteria for chronic HTN superimposed on preeclampsia? (2)
new onset proteinuria after 20th week of gestation
sudden/significant increase in BP in a previously controlled BP patient
what will have signs consistent with severe preeclampsia?
chronic HTN superimposes on preeclampsia
what is gestational HTN? (2)
transient HTN
HTN without proteinuria before 20 weeks GA
HTN without proteinuria withn 48-72 hours after delivery
when does gestational HTN resolve?
12 weeks postpartum
what is the cause of epigastric pain in a patient with preeclampsia?
stretching of the liver