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Describe the typical pattern of BP during pregnancy
BP decreases in weeks 7 to 24, then rises to pre pregnancy norms by term
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Hematology
(plasma, RBC, total blood volume)
50% plasma increase
450mL Red cell volume
35% total volume increase
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What is mild and severe chronic HTN
HTN present before preg or before 20 wks gestation.
Mild SBP >140 and/or DBP >90
Severe SBP >180 or DBP >100
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What is the major risk with chronic hypertension?
Superimposed preeclampsia and eclampsia
Look for proteinuria
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Treatment of chronic HTN
Goal : ↓ stroke risk
Methyldopa, labetolol, nifedipine.
D/C diuretics
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What is the definition of gestational HTN?
- Develops after 20 wks
- NO PROTEINURIAReturns to normal after pregnancy
Assume it is or will become preeclampsia!
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Define preeclampsia..
BP SBP >140 or DBP >90 after 20 weeks in a woman with previously normal BP
> 300mg protein in 24 hrs
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What are the criteria for Severe Preeclampsia
(ALWAYS AN INDICATION FOR DELIVERY)
SBP >160 or DBP >110 on 2 occasions at least 6 hrs apart while patient on bedrest
> 5g protein in 24 hrs or >3+ on two dipsticks
<500ml urine in 24 hrs
Cerebral or visual disturbances (HA, Scotomata)
RUQ Pain
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More Severe Preeclampsia
- hepatic dysfunction
- thrombocytopenia
- IUGR
ALWAYS AND INDICATION FOR DELIVERY..
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What is the major pathophysiology behind preeclampsia
MATERNAL VASOSPASM
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What are some risk factors for PreE
- Nulliparous
- Multiple gestation
- age >35
- Obesity
- Af-American
- Chronic HTN
- Pregestational DM
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Whats behind the pathophysiology for PREE
- Inadequate vascular remodeling in uterus and placenta
- activation of coagulation cascades (larger platelets)
- reduced plasma volume
- glomeruloendotheliosis
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What is different about edema and DTRs in PreE
Edema is in face, hands, sacral region, or doesn't go away after lying down
Hyperreflexia in patellar and achilles tendons especially - - ANKLE CLONUS IS BAD
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T/F
Strict bedrest is proven to be the most effective treatment for severe Pre E
False. Strict bedrest can increase risk of neonatal mortality and morbildity due to immobility
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MONITORING FOR PreE (4)
2X week:
- NST and or BPP
- Testing for IUGR or oligohydramnios
US for growth and amniotic fluid Q3wks
Daily Kick counts
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What is MgSO4 used for and what is the antidote
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- Prevention of seiures related to eclampsia
- Not an antihypertensive
Antidote is Ca Gluconate
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What is the therapeutic level of Mag
4-6mg/dL
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What is the definition of H E L L P syndrome?
- Hemolysis
- Elevated Liver enzymes
- Low Platelet count (usuallyl <50,000)
Most telling sign is RUQ pain
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What is Eclampsia?
Grand mal seizures not related to a neuro disorder in a patient with pre-eclampsia
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About what percentage of patients with gestational HTN will develop pre E later in pregnancy
25%
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What is the mainstay of treatment for preeclampsia
Rest and frequent monitoring
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