Miscellaneous
Gestational Hypertension
Pre-eclampsia I
Pre-eclampsia II
Pre-eclampsia treatment
100

What is the deadly triad of pregnancy?

Hypertension, hemorrhage, infection

100

How do you diagnose gestational hypertension?

1) BP >/=140/90

2) first time
3) No proteinuria
4) >2 BP readings, >4 hours apart

100

What is the only cure?

Delivery of the placenta

100
In what population does pre-eclampsia most frequently occur in?

Pregnant 

Healthy, nulliparous with no obvious risk factors

100
What labs do you order?

CBC, CMP (liver enzymes, creatinine), urine protein (24 hour or protein/creatinine ratio)

200

Incidence of Pre-eclampsia in the US?

5%

200

When is it commonly diagnosed?

3rd trimester

200

Who gets aspirin for prevention?

Early onset pre-eclampsia and preterm delivery <34 weeks in more than one pregnancy
200

True or false: A headache is a reliable indicator of pre-eclampsia

False 

Unreliable and nonspecific

200

When do you deliver?

1) >37 weeks 

2) suspected placental abruption 

3) > 34 weeks + (other features)

300

What is HELLP syndrome?

1) hemolysis 

2) Elevated liver enzymes 

3) Low platelets

300

What is the timeline?

>20 weeks gestation 

to 12 weeks postpartum

300

How high should liver enzymes be to count towards this diagnosis?

two times normal

300

Risk factors for Pre-eclampsia?

Nulliparity, multifetal gestations, prior pre-eclampsia, chronic HTN, diabetes, thrombophilia, SLE, BMI>30, Antiphospholipid syndrome, AMA, kidney disease, OSA, assisted reproductive technology

300
When can you manage as outpatient?

1) 32-37 weeks 

2) BP<150/100

3) Normal LFTs, platelets

4) No severe features

400

What features are no longer used to evaluate severe pre-eclampsia?

Severe proteinuria (>5g/24h)

Hyperreflexia

400
What can you rename it when it resolves?

transient hypertension of pregnancy

400

Common symptoms?

Headache, visual changes, epigastric pain, shortness of breath
400
What can severe pre-eclampsia cause?

pulmonary edema, ARDS, MI, stroke, renal failure, retinal injury, coagulopathy

400
What are the other indications for delivery when mom is at 34 weeks? (Hint: there are four)

1) progressive labor or ROM

2) Fetal weight <5th percentile 

3) oligohydramnios 

4) Persistent BPP 6/10 or less

500
How has the rate of pre-eclampsia changed in the US since the 1980s?

Increased by 25%

500
Up to what percentage of patients will develop pre-eclampsia?

Up to 50%

500

What 5 new onset features in combination with new onset hypertension would give this diagnosis?

1) Thrombocytopenia (platelets <100,000)

2) Renal insufficiency: Creatinine > 1.1 or doubling

3) Impaired liver function (increased LFTs)

4) Pulmonary edema 

5) Cerebral or visual symptoms

500

What is thought to cause RUQ pain or epigastric pain in pre-eclampsia?

periportal and focal parenchymal necrosis

hepatic cell edema 

Glisson's capsule distention

500

When do you treat with antihypertensives?

ACOG does not recommend treatment for BP <160/110

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