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High Risk

Hypertension

QuestionAnswer
Chronic hypertension is classified as >140/90 BEFORE 20 wks gestation
Gestation HTN is classified as >140/90 20 wks or greater gestation
Mild preeclampsia has __ protein and ___ urine +1 protein; >300 mg/24hr urine
T or F: Mild preeclampsia does not have weight gain r/t fluid retention FALSE. Mild preeclampsia DOES show wt. gain r/t fluid retention
Mild preeclampsia has edema located in __ Face and hands
What PO meds are given for mild preeclampsia? Nifedipine, Labetolol unless BP continues to increase. Then will Tx with stronger HTNsives until Mag Sulfate is needed.
Mild preeclampsia PLTs may be... Normal
Severe preeclampsia shows BP reading of __/__ >160/110
Mild preeclampsia shows BP reading of __/__ >140/90
The classic triad of sx for preeclampsia include Edema, proteinuria, hypertension
Severe preeclampsia has __ protein on dipstick, __ mg/__ hours urine 3+ protein, >500 mg/24hr urine
T or F: severe preeclampsia shows 2+ DTRs False. Will have 3+/4+ DTRs since hyperreflexia a sx
T or F: severe preeclampsia, mother may complain of headache True
Severe preeclampsia shows edema in what places? Generalized, including face/hands
Mother may c/o ____ r/t fluid retention in severe preeclampsia Weight gain
Oliguria presents in which HTN disorders? Severe preeclampsia, eclampsia
If a mother with HTN c/o of epigastric or RUQ pain, you suspect which organ is affected? Which HTN category will these sx appear in? Liver; epigastric/RUQ pain presents in severe preeclampsia/eclampsia
Scotomata refers to ___ and is seen if the mother has ___ Blind spots; severe preeclampsia/eclampsia
True or false: Blurry vision is a sx of gestational hypertension False. Blurry vision sx of severe preeclampsia/eclampsia
Pulmonary edema is seen in pts. with ______ Severe preeclampsia/eclampsia
HELLP stands for Hemolysis, elevated liver enzymes, low platelets
HELLP presents during... Severe preeclampsia/eclampsia
True or false: magnesium sulfate should not be given with Pitocin d/t its toxic effects False. Mag Sulfate can be used with Pitocin
True or false: Thrombocytopenia is seen in severe preeclampsia and eclampsia. Lab values show plats are < 150,000 False. Lab values show PLT < 100,000
Chronic HTN is assessed during __ trimester and before __ wks 1st, before 20 wks
Gestation HTN is assessed in __ trimester and after __ 20 wks 2nd, 3rd trimester, AFTER 20 wks
What are recommendations for women with chronic HTN/GH? Reduce activity, treat with antihypertensives like labetolol/procardia (aka nifedipine)
True or False: gestational HTN may be asymptomatic True
When D/C teaching, you tell a mother that chronic HTN does __ postpartum NOT resolve
What is the primary mechanism of GH? Vasospasm; hypo-perfusion of mother's organs/placental blood flow... may affect all organ systems
A mother with GH explains to you that her HTN will go away by 2 wks pp. How do you respond? Explain elevated BP goes away usually by 12 wks PP.
_____ is an ominous sign before seizure (eclampsia) Epigastric pain
___ therapy is used preventatively to decrease what in high risk moms? Aspirin therapy; used to decrease vessel wall damage
List 6 major MATERNAL complications of preeclampsia 1) seizures, 2) placental abruption, 3) retinal detachment, 4) renal failure, 5) cerebral hemorrhage, 5) HELLP/liver rupture
List 4 major FETAL complications of preeclampsia 1) IUGR, 2) chronic hypoxemia, 3) acute hypoxemia, 4) death
A baby whose mother has preeclampsia will show a __ HCT level High (d/t chronic hypoxemia)
When a mother is Dx with a HTNsive disorder, you must do what types of fetal tests? Fetal US, weekly NST (non-stress test), amnio (lung maturity), doppler velocimetry (blood flow)
You ask the mother to count daily fetal kicks. She asks what is "normal" amount of kicks for a healthy baby. You respond... 12 kicks/day, or track # kicks/1-2 hrs your baby usually does.
A mother has her Magnesium levels drawn. Results: 8.9. You know this is a __ level. High! Normal mag levels are 4-7
What sort of adverse effects should you warn a mother about Mag Sulfate? Dizzy, hot flashes, difficulty catching breath
How often should you draw Mag levels? q6h
Activity level while on Mag should be Strict bedrest
S/sx of magnesium toxicity include Depressed RR (<12), decreased LOC, absent reflexes/clonus, urine output < 30cc/hr
The antidote to mag toxicity is ___ Calcium gluconate
True or false: you will always see a rise in BP before HELLP presents FALSE. 20-25% cases have HTN absent before mother presents with HELLP
Preterm labor is defined as Mother going into labor before completed 37th week
Requirements for PTL include what type of uterine cx and cervical dilation? Regular uterine cx (4/20min or 8/1 hr) and cervical dilation >=2
Risk factors for PTL include Hx of PTL, low literacy, "rule of toos"
Causes of PTL Infection, stress, trauma, multiples
Fetal fibronectin (fFN) does what? Why is it used diagnostically? Attaches amniotic sac to lining of uterus. Increased levels BEFORE 35 wks shows risk of PTL
First thing you do with mother at risk of PTL HYDRATION. Dehydration may encourage woman to contract
If rest/hydration doesn't work for PTL, then give what? Drugs: Mag sulfate, terbutaline, nifedipine, NSAIDs (motrin)
Why is Mag sulfate used for PTL? Relaxes uterus
Mag sulfate doses: loading vs. maintenance 4 gm loading over 20 minutes, then 1 gm/hr
Terbutaline does what for PTL? Relaxes uterus
Terbutaline should raise heartrate to ____ for therapeutic range above 110
True or false: betamethasone requires 2 doses 24 hours apart True
Why is betamethasone given to PTL moms? Increases surfactant production of babies' lungs, help maintain inflation of lungs
What HIV drug is given at any stage of pregnancy to woman and NB? AZT
Management of newborn delivered by HIV+ mom Bathe on admission, treat with AZT
Why is C-S preferred in HIV+ mom? Less blood exchange, more control, less trauma
Leading cause of PROM/PTL Infection (#1 UTI, also dental)
Why does infection cause PTL? Release of prostaglandins
___ is known as infection of amniotic sac and typically has a "death smell" Chorioamniitis
When should GBS be Tx? During labor, 1 dose 4 hours BEFORE birth for baby
S/sx of sepsis in baby Very cold or warm, mottled skin, poor feeding, fussy, lethargic, acts "sick"
S/sx of chorio in mom Abd pain, elevated WBC
Predisposing factors to UTI Hygiene, nutrition, anemia, DIABETES
_________ is considered teratogenic Hyperglycemia
What DOES NOT cross placenta? Insulin
Macrosomia is seen in mothers with Diabetes
First line Tx of diabetes: Diet, exercise, BG control
Second line Tx of diabetes PO meds (Glyburide)
Third line Tx of diabetes Insulin
S/sx of hypoglycemic babies Shaky, poor feeding, fussy, sweating
Gestational DM should resolve in __ 6 weeks
Important teaching points to moms with gestational diabetes (about mom and baby): Mother's chances of getting DMII is 60%, baby 45% more likely to have Metabolic Syndrome as adults
Babies born from diabetic moms should have __ BG checks and if < __ give formula/colostrum 4-6 BG checks. If <45 give formula/colostrum
When is gestational diabetes detected? 2nd and 3rd trimester by GTT (glucose tolerance test). If obese, do GTT in 1st trimester
List maternal complications of diabetes (5) 1) Ketoacidosis, 2) hypoglycemia, 3) INFECTION, 4) PIH, 5) hemorrhage
List newborn complications of diabetes (3) Hypoglycemia, macrosomia d/t hyperinsulinemia, IUGR if diabetes + severe PIH
Created by: lapio-obgyn