Definition
This condition is defined as hypertension first detected after 20 weeks gestation in a woman who was previously normotensive
What is gestational hypertension?
A central pathogenic mechanism in preeclampsia is the failure of transformation of these structures in early pregnancy, resulting in chronic uteroplacental ischemia
What are the spiral arteries?
Protein-to-creatinine ratio threshold used as a screening tool for preeclampsia in hypertensive pregnancies
What is P/C ≥ 0.30?
Also excretion of at least 300 mg of protein in a 24–hour urine collection
If have to use dipstick: 2+
First‑line oral agents for maintenance therapy of chronic hypertension during pregnancy
What are nifedipine and labetalol?
Pregnancies complicated by preeclampsia often result in this condition for the fetus.
What is fetal growth restriction?
FGR is fetal birth weight <10th percentile for gestational age
Other neonatal risks: preterm birth, IUFD, congenital anomalies
ACOG defines this condition as hypertension present before pregnancy or before 20 weeks
What is chronic hypertension?
A maternal BMI greater than this value is considered a moderate risk factor for developing preeclampsia.
What is BMI >30?
Blood pressure criteria to diagnose gestational hypertension
What is two BPs ≥ 140/90 and ≥ 4 hours apart after 20 weeks gestation?
Delivery timeline for patients with gestational HTN or preeclampsia
What is 37 weeks?
Delivery
- cHTN, controlled (+/- meds): 38-40wks
- cHTN uncontrolled: 36-38wks
- gHTN or PreE: 37wks
- Severe features: 34wks
Both gestational hypertension and pre‑eclampsia raise the risk of this common late‑pregnancy complication
What is placental abruption?
BP ≥ 140/90 mm Hg plus ≥ 300 mg proteinuria in 24 hr describes this pregnancy complication.
What is pre‑eclampsia?
3 HIGH-risk factors for preeclampsia
What are history of preeclampsia, multi-fetal gestation, renal disease, autoimmune disease, Type 1 or 2 diabetes (pre gestational), and chronic HTN?
A systolic BP ≥ 160 mm Hg or diastolic ≥ 110 mm Hg in a pregnant patient
What is pre‑eclampsia with severe features?
High–risk women are advised to start this medication between 12 and 28 weeks’ gestation to reduce preeclampsia risk.
What is Aspirin 81 mg daily?
Chronic hypertension in pregnancy is associated with an increased risk of this complication occurring during the postpartum period.
What is postpartum hemorrhage?
Compared with normotensive women, those with chronic HTN have 2x risk of PPH.
A sudden rise in BP and new proteinuria in a woman with longstanding hypertension signals this “double‑trouble” diagnosis.
What is chronic hypertension with superimposed pre‑eclampsia?
What are 3 of the MODERATE-risk factors for preeclampsia?
What are first pregnancy, maternal age >35, obesity, FamHx of preeclampsia, low SES, African American race, IVF, personal history factors (LBW, SGA, >10 yr since last pregnancy)
List at least 2 severe feature lab findings for pre-eclampsia with severe features.
Severe feature labs for pre-eclampsia:
- Creatinine > 1.1 mg/dL or 2x normal
- Liver enzymes: 2x normal
- Platelets < 100 000/µL
For rapid control of acute severe hypertension (>160/110) in pregnancy, this IV medication is given as a bolus starting at 10–20 mg, but it is contraindicated in women with asthma.
What is labetalol?
This severe complication of preeclampsia is characterized by multi-system organ dysfunction.
What is HELLP syndrome?
Characterized by hemolysis, elevated liver enzymes, and low platelet count.
LDH >600 IU/L
AST and ALT >2x normal
Low Plt < 100,000/µL
Main presenting symptoms: RUQ pain and malaise in up to 90% of cases.
HELLP is mostly a third-trimester condition, but 30% of cases occur postpartum.
During the aggravation phase: 40% decrease in platelets per day.
With supportive care alone, 90% of patients with HELLP will have plt >100,000 and decreased liver enzymes within 7 days of delivery.
When gestational hypertension pressures hit ≥ 160/110 mm Hg, ACOG says the disorder is now classified as this.
What is pre‑eclampsia with severe features?
Preeclampsia is linked to an imbalance between a potent vasoconstrictor and a vasodilator. This vasoconstrictor, found in excess, is a key player in the disease’s pathogenesis
What is thromboxane A₂?
Preeclampsia and eclampsia are in part due to the interaction of various vasoactive agents:
- Thromboxane A₂ (potent vasoconstrictor)
- Prostacyclin (vasodilator)
- Nitric oxide (potent vasodilator)
- Endothelins (potent vasoconstrictors)
Aspirin is a thromboxane A₂ inhibitor -> prevention of preeclampsia
ACOG lists this tie‑breaker lab when it’s hard to distinguish worsening chronic hypertension from this superimposed pre-eclampsia.
What is uric acid elevation?
In setting where patient has chronic HTN and baseline labs are already abnormal (e.g. proteinuria), increased uric acid, associated with placental dysfunction and endothelial damage, would suggest preeclampsia.
Hyperuricemia occurs because of increased production and increased reabsorption/decreased excretion in proximal renal tubules.
For seizure prophylaxis and treatment in severe pre‑eclampsia or eclampsia, ACOG recommends this IV medication. What is the therapeutic range?
Mg therapeutic range: 2-3.5 mmol/L, 4-7 mEq/L, or 5-9 mg/dL
IV 4-6 g loading dose over 20-30 minutes, followed by maintenance dose of 1-2 g/hr.
As Mg concentration gets higher outside of therapeutic range:
- Loss of patellar reflexes
- Respiratory paralysis
- Cardiac arrest
Mg excreted renally.
Pre‑eclampsia increases a woman's risk for this disease
What is cardiovascular disease?
Doubled risk of CV disease.