Most common cause of pregnancy related death is _____
Cardiovascular disease
What are etiologies that can lead to acute hypertension in pregnancy?
Gestational htn
Preeclampsia with/without severe features
Eclampsia
HELLP syndrome
Superimposed preeclampsia is a condition in pregnancy due to ______ hypertension
Preexisting/ chronic
Chronic hypertension is defined as:
Htn that is previously diagnosed before 20 weeks of pregnancy
Or htn persists 3 months post partum
Chronic hypertension is hypertension before _____ week of pregnancy or hypertension that persists _____ post partum
20
3 months
How is diagnosis of chronic hypertension made, according to the JNC 7 guideline?
Take 3 readings at least one week apart
Stage 1 hypertension is_____ and stage 2 hypertension is_____
140-159/90-99 (mild)
Greater than 160/100 (severe)
T/F staging chronic hypertension is usual practice in OB
False; they don’t stage
Mom with chronic hypertension are at risks for which conditions?
Placental abruption
Pulmonary edema
Stroke
Superimposed preeclampsia
End organ damage
Cesarean delivery
Chronic hypertension risks to fetus include:
Fetal growth restriction
Still birth
Preterm birth
For chronic htn fetal assessment, get baseline US at ______ weeks, and run ______ testing
16-20 (third trimester to assess for fetal growth)
Third trimester antenatal testing (non stress test, AFV, doppler velocimetry of umbilical artery)
Postpartum for chronic hypertension mom, what is the drug that might cause elevated BP?
NSAID use for pain
Chronic hypertension (non preeclampsia) mom not on medication can deliver at ______ weeks, those that are on medication should deliver at _____ weeks and those with severe htn should deliver at _____ weeks
38-40
37-40
36-37
First line drug treatment for OB hypertension is_____
Labetalol
Can add calcium channel blocker if needed
T/F: Women with chronic hypertensions, regardless of severity should all get treated when pregnant in order to prevent end organ damage and ensure adequate fetal growth
False; mild (<150/ 100) and moderate hypertension (150-160/100-109) have no or unclear benefit respectively, only severe (> 160/110) is treatment warranted
Overzealous treatment could be harmful because decreases placental profusion
Which drugs are safe and preferred medications in pregnancy?
Hydralazine
Methyldopa
Labetalol
Nifedipine
(Hypertensive Mothers Love Nifedipine)
Which drugs are contraindicated in hypertensive pregnant women?
ACE inhibitors
ARBs
Direct renin inhibitors
Women with chronic hypertension who develops worsening htn with new onset proteinuria is _____
Superimposed preeclampsia
How does trophoblastic tissue behave differently between normal pregnancy and preeclampsia?
Trophoblastic tissue in preeclampsia does not dive as deep into the myometrial layer, so more superficial and higher resistance than normal pregnancy (normal allows for increased blood flow)
Gestational hypertension has systolic of ______ And/or diastolic of ____ measured _____ hours apart in a previous normotensive woman
Greater or equal to 140
Greater or equal to 90
4 hours
What is the clinical presentation of Preeclampsia without severe features ?
>140/90 on two separate occasions
Proteinuria 300 mg on a 24 hour urine collection
Gold standard to diagnose proteinuria?
24 hour urine collection (> 300 mg for diagnosis)
T/F: Preeclampsia is diagnosed when the woman has 2 readings of BP >140/90 and urine dip stick comes back with +protein of greater than 300mg
False; yes to the BP reading, but no to urine dipstick, because it is not diagnostic only provide as clue. Diagnostic proteinuria is 24 hour urine collection
T/F: pregnant woman with repeated hypertensive readings of >140/90 is said to have preeclampsia
False; just hypertension alone is known as gestational hypertension; preeclampsia is diagnosed when there is also proteinuria in addition to the hypertension
T/F: preeclampsia WITH severe features is hypertension + proteinuria + other severe features
False; they may or may not have proteinuria, but have hypertension and other severe features such as visual disturbance, headache, pulmonary edema, low platelet, elevated liver enzyme, renal insufficiency
What is the ACOG recommendation for acute treatment of severe hypertension?
When systolic greater/equal to 160 and/or diastolic greater/equal to 110 that persists for longer than 15 minutes should be treated in 1 hour with IV labetalol or IV hydralazine or oral nifedipine
What is Eclampsia?
development of grand mal seizures in a woman with preeclampsia, in the absence of other neurologic conditions that could account for the sz
Vasogenic edema in bilateral parietal lobe (hyper intensity in MRI)
T/F: women with blood pressure of 140/100 with severe features (signs of end organ damage) are more likely to have eclampsia than women with blood pressure of 160/110s
True; the magnitude of hypertension does NOT correlate with risk of eclampsia
When can eclampsia occur during pregnancy?
can occur from second trimester through post partum period
Eclampsia is a clinical manifestation of _____
Severe preeclampsia
Strokes account for ____% of eclampsia death
20
T/F: rarely do you need to put a patient on seizure medication when treating for eclampsia
true
Parthenogenesis of eclampsia can be due to _______
vasospasm of cerebral arteries
underperfusion of brain
localized ischemia
cerebral edema
Treatment for eclampsia:
Loading and maintenance doses of magnesium sulfate to prevent next seizure (does not help with current seizure)
An African American 35 year old nulliparous woman not currently receiving anti-seizure prophylaxis during her pregnancy c/o RUQ pain sudden increased in facial edema, what might be the cause of her pain?
Liver is experiencing end organ damage, a preemptive symptom of eclampsia
Everything listed is risk factor eclampsia, and sudden edema/weight gain is due to capillary leaking
As a result of eclampsia seizure, if fetal heart tone is bradycardia and lasts for more than 10-15 minutes after giving the mother Magnesium sulfate and severe htn treatment, what would you be suspicious of?
Placental abruption
What is seizure prophylaxis given for eclampsia prevention?
Magnesium sulfate IV for preeclampsia with severe features. Steroid if < 37 weeks and continue 24 hours post partum
Presence of burr cell and schistocytes:
HELLP
In HELLP, liver enzymes are _____ and platelet count is ____
Elevated
Low (< 100,000)
T/F: lower risk of preeclampsia in smokers
True. Just like smokers have lower risk of endometrial cancer. Must be nice to smoke
Creatinine value is ___ in preeclampsia with severe feature
Doubled (in the absence of other renal disease)
Treatment of preeclampsia is ____
Delivery
Deliver the baby at 37 weeks when:
Chronic hypertension and not on medication
Gestation hypertension (though 38-39 if stable)
Preeclampsia without severe features
Preeclampsia with severe features, should ideally deliver at _____ week, but If un able to control pressure and lab values worsening, deliver _____
34
Deliver after steroids
Delivery for eclampsia/ HELLP:
If maternal and fetal status are reassuring, give steroids and deliver at any gestational age
If hypertension is seen in mother less than 20 weeks in pregnancy, should consider ______
molar pregnancy (snowstorm appearance!) – no fetal parts present
