Show:
Chronic hypertension
Preeclampsia
Severe features
Treatment
Misc
100

Definition of chronic hypertension in pregnancy

SBP >=140 mmHg or DBP >=90mmHg x2 occasions at least 4 hours apart, present before pregnancy or before 20 weeks of gestation

100

Risk factors for preeclampsia

Preeclampsia in a previous pregnancy

Nulliparity

Multifetal gestation

Chronic hypertension

Advanced maternal age

Obesity

Pregestational diabetes

SLE, APLS

IVF pregnancy

Etc.

100

Diagnosis of preeclampsia with severe features

BP >= 160/110 x2 occasions 4h apart, or persistent requiring acute treatment

Platelet <100k

LFTs twice upper limit of normal

Cr >1.1 or twice baseline

Pulmonary edema, persistent headaches, visual disturbances, persistent RUQ or epigastric pain

100

Contraindications to magnesium sulfate

Myasthenia gravis

Hypocalcemia

Moderate-to-severe renal failure

Cardiac ischemia, heart block, myocarditis

100

Timing of low-dose aspirin for preeclampsia prophylaxis

Between 12 and 18 weeks, ideally before 16 weeks

200

The physiologic trend of BP in pregnancy

Decrease in systemic vascular resistance leading to lower BP, nadir at 16-18 weeks, return to pre-pregnancy level by the third trimester

200

Initial workup for preeclampsia

Labs including CBC, Cr, AST, ALT, LDH, evaluation of proteinuria
200
It is recommended that persistent severe range BPs are acutely treated within what time frame?

30-60 minutes

200

Therapeutic range for serum magnesium

4.8 - 9.6 mg/dL (4-8 mEq/L)

200

Management of supratherapeutic magnesium level/mag toxicity 

Stopped magnesium. 

Mag level q2h.

Restart at lower rate when <8.4.

Calcium gluconate 10%, 10mL IV if impending respiratory depression

300

BP goal for patients with cHTN

<140/90

300

A patient at 34 weeks gestation with no prior diagnosis of HTN, has an isolated BP of 160/110 and proteinuria. What diagnosis does she have?

Preeclampsia.


BP 140/90 or more x2 occasions more than 4 hours apart. OR 160/110 or more x 1 time

AND

Proteinuria OR if no proteinuria, other lab abnormality or symptoms

300

Medication options for acute treatment of persistent severe range BPs and dosage

Labetalol, 20mg incr, max 300mg

Hydralazine, 5-10mg incr, max 20mg 

Nifedipine, 10-20mg incr, max 180mg daily

300

Timing of onset of action for short-acting labetalol, hydralazine, nifedipine

Labetalol: 1-2min

Hydralazine: 10-20 min

Nifedipine: 5-10 min

300

Serum magnesium levels and correlating toxicities

>9 Loss of patellar reflexes

>12 respiratory depression

>30 cardiac arrest

400

Common maintenance antihypertensives used in pregnancy and max dosage

Labetalol, 2400mg max daily

Nifedipine XR, 120mg max daily

Methyldopa, 3000mg max daily

HCTZ, 50mg max daily

400

Methods of evaluation of proteinuria

From best to worst:

24h urine protein: 300mg or more

UPCR: 0.3 or more

Dipsticks: 2+ protein or more

400

Conditions that preclude expectant management of patients with preeclampsia w/ SF

Maternal: 

- Uncontrolled SR BP

- HELLP, eclampsia

- Cr >1.1

- persistent headaches, persistent RUQ/epigastric pain, visual disturbances/motor deficit, stroke, MI

- Placental abruption

Fetal:

- Fetal death; fetus without expectation for survival 

- Abnormal fetal testing

- Persistent REDV of umbilical artery

400

Delivery timing for gestational hypertension, preeclampsia and preeclampsia with severe features

gHTN and PEC w/o SF: 37+0

PEC w/ SF: 34+0

400

Number needed to treat with magnesium sulfate to prevent one case of eclampsia in patients with preeclampsia w/ SF

36

500

Delivery timing for chronic hypertension controlled with and without medications

Without medication: 38 - 39+6

With medication: 37 - 39+6

500

Maternal and fetal monitoring for patients with gHTN, preeclampsia and preeclampsia w/ SF

Maternal: frequent BP monitoring, weekly labs

Fetal: EFW, amniotic fluid assessment, antepartum testing 1-2x/week

500

Diagnosis of HELLP syndrome

Platelet: <100k

AST/ALT: double upper limit of normal, usually in the hundreds

LDH >600

500

Contraindications/side effects of short-acting labetalol, nifedipine, hydralazine

Labetalol: avoid with asthma, myocardial disease, heart block, bradycardia, decreased EF

Nifedipine: reflex tachycardia, headaches

Hydralazine: higher risk of maternal hypotension, headaches, abnormal EFM

500

The correct technique to measure blood pressures

Correct cuff size

Patient seated with legs uncrossed and back supported, if laying down: left lateral decubitus position and cuff at level of right atrium.

No caffeine or tobacco at least 30 min before

Patient has rested for at least 10 min or more