Obstetrics
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| If a young female patient is hypertensive and having a seizure she is __ until proven otherwise | Preeclamptic
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| Hypertension complicates __ of all pregnancies | 5-7%
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| Preeclampsia/eclampsia is responsible for __% of hypertension in pregnancy | 70
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| Hypertension with proteinuria and pathologic edema | Preeclampsia
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| Hypertension without proteinuria or pathologic edema during pregnancy (after 20th week or persists 12 wks post partum) = | Pregnancy-induced hypertension
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| Hypertension with proteinuria and/or pathologic edema with convulsions | Eclampsia
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| Signs and symptoms of preeclampsia | HA, hyperreflexia, visual changes, irritability, epigastric pain, edema of face/hands/abdomen, oliguria
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| What does HELLP stand for | Hemolysis, Elevated Liver enzymes, Low Platelets
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| Primary symptom of HELLP syndrome | Malaise, fatigue
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| Classic presentation of HELLP syndrome | Malaise/fatigue, N/V, HA, RUQ pain, severe elevated BP, 3+ protein/85% of the time
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| Characterized by the onset of hypertension and proteinuria, usually during the third trimester of pregnancy | Preeclampsia
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| 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
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| An ECG may reveal __ in the patient with long-standing hypertension | Left ventricular hypertrophy
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| What is mild hypertension | Systolic >/= 140, diastolic >/=90
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| What is severe hypertension | Diastolic >/= 180, diastolic >/=110
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| 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
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| new onset of grand mal seizures in a woman with preeclampsia that cannot be attributed to other causes | Eclampsia
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| how is preeclampsia distinguished from gestational hypertension | There is no proteinuria in gestational hypertension
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| What are the mainline antihypertensives used during pregnancy | Methyldopa, labetalol, nifedipine
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| preeclampsia complicates __% of all pregnancies | 5-7
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| normal pregnancy is associated with decreased maternal sensitivity to __. This effect leads to expansion of the intravascular space | Endogenous vasopressors
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| 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
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| 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
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| lab work of patients with preeclampsia will reveal __ | Elevated levels of hematocrit, lactate dehydrogenase, serum transaminase, and uric acid, and thrombocytopenia
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| in the management of preeclampsia, with few exceptions, maternal interests are best served by __ | Immediate delivery
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| how are women with mild preeclampsia before 37 weeks managed | Expectantly with bed rest, twice-weekly antepartum testing, and maternal evaluation
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| severe preeclampsia mandates __ | Hospitalization
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| 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
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| In severe HTN what is the goal of antihypertensives | Systolic <160 and diastolic <105
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| In severe preeclampsia, acute BP control may be achieved with what drugs | 1stline: methyldopa; 2nd: hydralazine; 3rd: labetalol
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| In severe preeclampsia between 33 and 35 weeks consideration should be given to __ for pulmonary maturity studies | Amniocentesis
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| Loss of patellar reflexes is observed at magnesium levels of __mg/dL or higher | 10
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| Respiratory paralysis may occur at magnesium levels of __ or higher | 15
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| Severe preeclampsia tx: | Antihypertensives; c'steroids (improve liver/plt/ fetal lung devt); anticonvulsants (MgSO4); bed rest; Delivery Only Cure
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| Pre-eclampsia more common in what ages? | <18 y.o. or >35 y.o.
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| HELLP tx | FFP, blood transfusion, steroids, antihypertensives
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| HELLP fetal complications | abruptio placentae, IUGR, prematurity
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| HELLP maternal complications | DIC, pulmonary edema, death
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| Tx: prevents most eclamptic seizures = | Mg sulfate
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| Pregnant, HA, visual disturbance | Pre-eclampsia
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| Pre-eclampsia RFs | Nulliparity. <20 or >35 y.o. Multi gestation. DM. HTN. Previous eclampsia. Thyroid. Obesity. Fetal hydrops. Trisomy 13. Hydatidiform mole.
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| 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.
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| Meds for HTN in PG | Methyldopa firstline. Labetalol or CCB
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