Definitions
Etiology
Diagnosis/Medications
Severe PEC
Management
100
What are the four hypertensive diseases related to pregnancy?
What are: 1) cHTN 2) gHTN 3) Preeclampsia (including HELLP) 4) cHTN superimposed preeclampsia
100
Medical student question: Is preeclampsia more common in nulliparous or multiparous women?
What is nulliparous
100
Medical student question: How do you take an accurate blood pressure?
What is Use appropriate size cuff, length 1.5 x upper arm circumference - Take BP after 10 minute rest period, with no caffeine or tobacco for 30 minutes prior - Take BP in upright position, with arm at level of the heart, or perhaps left lateral recumbent for hospitalized pts
100
What is the definition of severe preeclampsia?
What is - BP SBP >160 or DBP >110, or proteinuria > 5gm/24 hrs - OR Evidence of end-organ damage: severe HA, visual symptoms, RUQ or epigastric pain, elevated liver enzymes, oliguria, IUGR <10%, lab anormalities: hemolysis, low platelets
100
***COMBO Question*** 1) True or false: Antihypertensives improve fetal outcome in hypertensive d/o of pregnancy? 2) Bonus: What range should we start antihypertensive treatment?
1) What is false 2) SBP 150-160, DBP 100-110
200
What is the definition of cHTN?
What is systolic pressure ≥140 mmHg and/or diastolic pressure ≥90 mmHg that antedates pregnancy or is present before the 20th week of pregnancy (on at least two occasions) or persists longer than 12 weeks postpartum
200
Multiple gestations increases or lowers your risk of pre-eclampsia?
What is INCREASES. It is also increased with cHTN, hx of preeclampsia, APA and AMA, obesity, diabetes, connective tissue d/o
200
These are the maternal risks of pre-eclampsia:
What are CVA, acute renal failure, hepatic failure or rupture, DIC, eclampsia
200
What is (one) definition of HELLP based on the article?
*) Sibai - hemolysis on peripheral smear, LDH>600, or tbili>1.2 - AST>70 - Plat <100 *)Martin - LDH>600 - AST or ALT >40 - Platelet <150
200
This is the gestational age when to deliver a patient with mild preeclampsia:
37 weeks
300
What is the definition of gestational hypertension?
What is hypertension without proteinuria or other signs/symptoms of preeclampsia that develops after 20 weeks of gestation. It should resolve by 12 weeks postpartum.
300
Smokers have a higher or lower risk of preeclampsia
What is LOWER! Surprised? So was I...
300
These are the labs we check, and the type of abnormality we expect in preeclampsia evaluation
- HCT: hemoconcentrated - Platelets: thrombocytopenia (<100,000) - ALT/AST: twice the upper limit of normal) - Elevated Cr (often >1.3) - Hemolysis (microangiopathic): abnormal peripheral smear, elevated bili, low haptoglobin - 24h urine proteine (>300mg or 5g)
300
This is the maximal gestational age we deliver severe preeclamptics
What is 34 weeks
300
Magnesium sulfate, the seizure prophylactic medication used in preeclampsia has these side effects which we monitor for:
What are pulmonary edema, nausea, flushing, visual disturbances, respiratory depression, cardiac arrests Think magnesium checks! - CV/resp exam - Check reflexes for magnesium overload
400
This physician popularized the use of magnesium sulfate for seizure ppx in 1925:
Who is Lazard. Other methods for treatment were Purging. Seizures were thought to be secondary to "repletion" so people also used phlebotomy, purgation, induction of diuresis.
400
This is the incidence of preeclampsia.
What is 5-7% of all pregnancies. - Note: 15-25% of gHTN will develop PEC
400
This percentage of preeclamptic patients have been shown to have no proteinuria
What is 10%
400
Your preeclamptic patient in OB triage seizes! She has no IV. You are going to give her this medication at this dose:
What is magnesium sulfate 5 mg in each buttock. - Note if IV then give 4-6mg IV loading dose over 15-20min, followed by 2g/hr - Can also use Diazepam or lorazepam, but not as effective - Magnesium sulfate is contraindicated in MG
400
This is the therapy for magnesium sulfate toxicity (including dose)
What is Calcium gluconate (1gm IV over 10 min) to counteract life-threatening Mg toxicity
500
What is Preeclampsia?
Preeclampsia refers to the new onset of hypertension and proteinuria >300 mg/24h urine after 20 weeks of gestation in a previously normotensive woman. BPs measured >6h apart but no more than 7d apart.
500
This is your risk of PEC in future pregnancy if you had it previously:
What is 5-7%.
500
This French physician of the 1600's if often credited with first writing about eclampsia and preeclampsia in the literature
Who is Mauriceau. A male midwife. He recorded: "The mortal danger to the mother and fetus is greater when the mother does not recover consciousness between convulstions". " Primigravidas are at far greater risk of convulsions than are multiparas"
500
This is the incidence of eclampsia in severe preeclamptics:
What is 2%.
500
This is the therapeutic range for magnesium sulfate therapy.
What is 4.8-8.4 BONUS: loss of DTR 9.6-12.0 mg/dl, respiratory paralysis 12.0-18.0, cardiac arrest 24-30
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