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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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