Hypertension in Pregnancy Clinical

  1. Most common cause of pregnancy related death is _____
    Cardiovascular disease
  2. What are etiologies that can lead to acute hypertension in pregnancy?
    • Gestational htn
    • Preeclampsia with/without severe features
    • Eclampsia
    • HELLP syndrome
  3. Superimposed preeclampsia is a condition in pregnancy due to ______ hypertension
    Preexisting/ chronic
  4. Chronic hypertension is defined as:
    • Htn that is previously diagnosed before 20 weeks of pregnancy
    • Or htn persists 3 months post partum
  5. Chronic hypertension is hypertension before _____ week of pregnancy or hypertension that persists _____ post partum
    • 20
    • 3 months
  6. How is diagnosis of chronic hypertension made, according to the JNC 7 guideline?
    Take 3 readings at least one week apart
  7. Stage 1 hypertension is_____ and stage 2 hypertension is_____
    • 140-159/90-99 (mild)
    • Greater than 160/100 (severe)
  8. T/F staging chronic hypertension is usual practice in OB
    False; they don’t stage
  9. Mom with chronic hypertension are at risks for which conditions?
    • Placental abruption
    • Pulmonary edema
    • Stroke
    • Superimposed preeclampsia
    • End organ damage
    • Cesarean delivery
  10. Chronic hypertension risks to fetus include:
    • Fetal growth restriction
    • Still birth
    • Preterm birth
  11. 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)
  12. Postpartum for chronic hypertension mom, what is the drug that might cause elevated BP?
    NSAID use for pain
  13. 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
  14. First line drug treatment for OB hypertension is_____
    • Labetalol
    • Can add calcium channel blocker if needed
  15. 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
  16. Which drugs are safe and preferred medications in pregnancy?
    • Hydralazine
    • Methyldopa
    • Labetalol
    • Nifedipine
    • (Hypertensive Mothers Love Nifedipine)
  17. Which drugs are contraindicated in hypertensive pregnant women?
    • ACE inhibitors
    • ARBs
    • Direct renin inhibitors
  18. Women with chronic hypertension who develops worsening htn with new onset proteinuria is _____
    Superimposed preeclampsia
  19. 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)
  20. 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
  21. 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
  22. Gold standard to diagnose proteinuria?
    24 hour urine collection (> 300 mg for diagnosis)
  23. 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
  24. 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
  25. 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
  26. 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
  27. 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
  28. Vasogenic edema in bilateral parietal lobe (hyper intensity in MRI)
    • PRES (posterior reversible encephalopathy syndrome
    • Seen in women with eclampsia
  29. 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
  30. When can eclampsia occur during pregnancy?
    can occur from second trimester through post partum period
  31. Eclampsia is a clinical manifestation of _____
    Severe preeclampsia
  32. Strokes account for ____% of eclampsia death
  33. T/F: rarely do you need to put a patient on seizure medication when treating for eclampsia
  34. Parthenogenesis of eclampsia can be due to _______
    • vasospasm of cerebral arteries
    • underperfusion of brain
    • localized ischemia
    • cerebral edema
  35. Treatment for eclampsia:
    Loading and maintenance doses of magnesium sulfate to prevent next seizure (does not help with current seizure)
  36. 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
  37. 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
  38. 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
  39. Presence of burr cell and schistocytes:
  40. In HELLP, liver enzymes are _____ and platelet count is ____
    • Elevated
    • Low (< 100,000)
  41. T/F: lower risk of preeclampsia in smokers
    True. Just like smokers have lower risk of endometrial cancer. Must be nice to smoke
  42. Creatinine value is ___ in preeclampsia with severe feature
    Doubled (in the absence of other renal disease)
  43. Treatment of preeclampsia is ____
  44. Deliver the baby at 37 weeks when:
    • Chronic hypertension and not on medication
    • Gestation hypertension (though 38-39 if stable)
    • Preeclampsia without severe features
  45. 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
  46. Delivery for eclampsia/ HELLP:
    If maternal and fetal status are reassuring, give steroids and deliver at any gestational age
  47. If hypertension is seen in mother less than 20 weeks in pregnancy, should consider ______
    molar pregnancy (snowstorm appearance!) – no fetal parts present
  48. What is used to treat magnesium toxicity?
    calcium gluconate
Card Set
Hypertension in Pregnancy Clinical
Endo Final