Definitions
This blood pressure reading, first detected after 20 weeks of gestation without proteinuria, defines gestational hypertension.
Systolic BP >/= 140 mmHg and/or diastolic BP >/= 90 mmHg on two separate occasions at least 4 hours apart.
What labs should be ordered in patients with suspected pre-eclamspia?
CBC, CMP, LFTs, lactate dehydrogenase, UPC, 24-hour urine collection
What medication is used to prevent eclampsia?
Magnesium
When should you deliver with gestational hypertension? (no severe range BPs)
37 weeks
Risk Factors for Preeclampsia (5)
Nulliparity, Multiple gestations, Pre-E in a previous pregnancy, cHTN, T2DM, GDM, Thrombophilia, Systemic lupus erythematous, Antiphospholipid antibody syndrome, BMI >30, Maternal age >/= 35 y/o, kidney disease, OSA, assisted reproductive technology
What is preeclampsia?
Hypertension (>/= 140/90) diagnosed first in pregnancy after 20 weeks + proteinuria
Preeclampsia is diagnosed with hypertension and this amount of proteinuria in a 24-hour urine collection.
≥300 mg
(protein-to-creatinine ratio of >/= 0.30)
What medications are used to urgently treat severe range BPs?
Labetolol, Hydralazine, Nifedipine (IR)
When should a patient be delivered if they have gestational hypertension with severe range blood pressures?
34 weeks
Women with a history of preeclampsia have an increased risk of developing what cardiovascular condition later in life?
Chronic Hypertension
This life-threatening condition involves seizures in a woman with preeclampsia
Eclampsia
What serum creatinine level indicates preeclampsia with severe features?
1.1 mg/dL or doubling of serum creatinine concentration
Labetolol should not be used for BP control in patients with...
Asthma, bradycardia, heart block, decreased heart function or preexisting myocardial disease.
Patients with preeclampsia without severe features should be delivered at what gestational age?
37 weeks
Common patient presentations of preeclampsia with severe features.
Persistent headache that doesn't improve with analgesics, rapid swelling of extremities, RUQ or epigastric pain, vision changes, new dyspnea
Preeclampsia with severe features by BP criteria can be diagnosed with this systolic or diastolic repeat blood pressure reading measured minutes apart.
Systolic BP ≥160 mmHg or diastolic BP ≥110 mmHg
Elevated liver transaminases to what level is considered a severe feature in preeclampsia.
Twice the normal concentration
What preventative medication can be given to individuals at high risk for developing preecalmpsia starting at 12-28 weeks.
Low-dose aspirin
A patient has preeclampsia with severe features. Both patient and fetus are stable. When should delivery occur?
34 weeks
Preeclampsia is associated with this fetal complication, characterized by birth weight below the 10th percentile for gestational age.
Fetal Growth Restriction
Define chronic hypertension with superimposed preeclampsia with severe features.
Chronic high blood pressure prior to pregnancy with development worsening high blood pressure and protein in the urine and/or other severe features during pregnancy.
Elevated lactate dehydrogenase (LDH) to >/= 600 IU/L, doubling of ALT and AST, and platelet count < 100,000 is indicative of what form of preeclampsia?
HELLP Syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count)
How long should magnesium be continued postpartum in a patient with preeclampsia with severe features?
24 hours
A patient has preeclampsia with severe features and is unstable. When should delivery occur?
Immediately after maternal stabilization
Describe the pathophysiology of preeclampsia.
Abnormal development of placental spiral arteries --> release of antiangiogenic factors into maternal blood stream --> systemic endothelial dysfunction --> clinical manifestations