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Eclampsia
Obstetrics
| Question | Answer |
|---|---|
| If a young female patient is hypertensive and having a seizure she is __ until proven otherwise | Preeclamptic |
| Hypertension complicates __ of all pregnancies | 5-7% |
| Preeclampsia/eclampsia is responsible for __% of hypertension in pregnancy | 70 |
| Hypertension with proteinuria and pathologic edema | Preeclampsia |
| Hypertension without proteinuria or pathologic edema during pregnancy (after 20th week or persists 12 wks post partum) = | Pregnancy-induced hypertension |
| Hypertension with proteinuria and/or pathologic edema with convulsions | Eclampsia |
| Signs and symptoms of preeclampsia | HA, hyperreflexia, visual changes, irritability, epigastric pain, edema of face/hands/abdomen, oliguria |
| What does HELLP stand for | Hemolysis, Elevated Liver enzymes, Low Platelets |
| Primary symptom of HELLP syndrome | Malaise, fatigue |
| Classic presentation of HELLP syndrome | Malaise/fatigue, N/V, HA, RUQ pain, severe elevated BP, 3+ protein/85% of the time |
| Characterized by the onset of hypertension and proteinuria, usually during the third trimester of pregnancy | Preeclampsia |
| Characterized by a history of high blood pressure before pregnancy, elevation of BP during the first half of pregnancy, or high blood pressure that lasts for longer than 12 weeks after delivery | Chronic hypertension |
| An ECG may reveal __ in the patient with long-standing hypertension | Left ventricular hypertrophy |
| What is mild hypertension | Systolic >/= 140, diastolic >/=90 |
| What is severe hypertension | Diastolic >/= 180, diastolic >/=110 |
| what is proteinuria as defined for preeclampsia | Urinary excretion of >/= 0.3g protein in a 24 hour urine specimen, usually correlates with a finding of 1+ or greater on dipstick |
| new onset of grand mal seizures in a woman with preeclampsia that cannot be attributed to other causes | Eclampsia |
| how is preeclampsia distinguished from gestational hypertension | There is no proteinuria in gestational hypertension |
| What are the mainline antihypertensives used during pregnancy | Methyldopa, labetalol, nifedipine |
| preeclampsia complicates __% of all pregnancies | 5-7 |
| normal pregnancy is associated with decreased maternal sensitivity to __. This effect leads to expansion of the intravascular space | Endogenous vasopressors |
| women destined to develop preeclampsia do not exhibit normal refractoriness to __. As a result normal expansion of the intravascular space does not occur | Endogenous vasopressors |
| in addition to the classic findings of hypertension and proteinuria, women with preeclampsia may complain of what other symptoms | Scotomata, blurred vision, HA, pain in epigastrium or RUQ, nondependent wt gain (hands/face), sudden wt gain (2/2 edema), hyperreflexia, ankle clonus |
| lab work of patients with preeclampsia will reveal __ | Elevated levels of hematocrit, lactate dehydrogenase, serum transaminase, and uric acid, and thrombocytopenia |
| in the management of preeclampsia, with few exceptions, maternal interests are best served by __ | Immediate delivery |
| how are women with mild preeclampsia before 37 weeks managed | Expectantly with bed rest, twice-weekly antepartum testing, and maternal evaluation |
| severe preeclampsia mandates __ | Hospitalization |
| In severe preeclampsia delivery is indicated if gestational age is __ weeks or greater, fetal pulmonary is confirmed, or evidence of deteriorating maternal or fetal status is seen | 34 |
| In severe HTN what is the goal of antihypertensives | Systolic <160 and diastolic <105 |
| In severe preeclampsia, acute BP control may be achieved with what drugs | 1stline: methyldopa; 2nd: hydralazine; 3rd: labetalol |
| In severe preeclampsia between 33 and 35 weeks consideration should be given to __ for pulmonary maturity studies | Amniocentesis |
| Loss of patellar reflexes is observed at magnesium levels of __mg/dL or higher | 10 |
| Respiratory paralysis may occur at magnesium levels of __ or higher | 15 |
| Severe preeclampsia tx: | Antihypertensives; c'steroids (improve liver/plt/ fetal lung devt); anticonvulsants (MgSO4); bed rest; Delivery Only Cure |
| Pre-eclampsia more common in what ages? | <18 y.o. or >35 y.o. |
| HELLP tx | FFP, blood transfusion, steroids, antihypertensives |
| HELLP fetal complications | abruptio placentae, IUGR, prematurity |
| HELLP maternal complications | DIC, pulmonary edema, death |
| Tx: prevents most eclamptic seizures = | Mg sulfate |
| Pregnant, HA, visual disturbance | Pre-eclampsia |
| Pre-eclampsia RFs | Nulliparity. <20 or >35 y.o. Multi gestation. DM. HTN. Previous eclampsia. Thyroid. Obesity. Fetal hydrops. Trisomy 13. Hydatidiform mole. |
| HTN mgmt in PG | Prenatal visit Q2-4 weeks at 34 weeks. Monitor BP & UA. Check fundal ht. Fetal monitoring at 32 wks. Deliver wk 39-40. Severe: fetal US Q2-4 wks at 32 wks. Deliver after wk 38. |
| Meds for HTN in PG | Methyldopa firstline. Labetalol or CCB |
Created by:
Abarnard
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