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Define ME!
HELLP!!
CHTN
PREC/Eclampsia
DRUGS!
100
BP >140/90 on at least 2 occasions, 4 hours apart within a 1 week pd No signs/symptoms of preeclampsia Elevated BP during pregnancy or in the first 24 hours postpartum BP must return to normal within 6 weeks postpartum
Gestational HTN
100
Criteria for diagnosing HELLP
Hemolysis Abnormal peripheral blood smear (schistocytes, burr cells, echinocytes) Increased bilirubin >1.2 Increased LDH >600 IU/L Elevated LFTs Increased AST > 72 IU/L Increased LDH > 600 IU/L Platelet count < 100,000/mm3
100
Medication for long-term management in pregnancy
Methyldopa 250mg BID 4g/day Labetalol 100mg BID 2400mg/day Nifedipine 10mg BID 120mg/day Thiazide 12.5mg BID 50 mg/day
100
Who is the guy responsible for most of the research regarding PREC... and the author of the chapter that I know you all read last night!
Baha M Sibai
100
Hydralazine: IV dose
5 - 10mg q 20 min MAX: 20 mg/hour
200
HTN present before pregnancy or dx before 20 wks HTN that exists more than 6 weeks postpartum
What is chronic HTN
200
DDX for HELLP
Acute fatty liver of pregnancy Appendicitis Gallbladder disease DM HUS, TTP, ITP Gastroenteritis, Peptic Ulcer Kidney Stones, Pyelonephritis, Glomerulonephritis SLE Viral Hepatitis
200
Definition of "low risk" CHTN
Low Risk: Uncomplicated essential HTN No previous perinatal loss Systolic pressure <180 and diastolic <110
200
Risk Factors
Nulliparity Prior history/Family history of PREC Multiple gestations Obesity Poor outcome in previous pregnancy IUGR, abruption, FDIU Preexisting condition CHTN, Renal Disease, IDDM 1 Thrombophilias Factor V Leiden
200
Labetalol: IV dose
20-40mg q 10-15 min MAX: 220mg
300
<160/110 Gestational HTN + proteinuria 0.1g/L or more in at least 2 random specimens collected 4 hours apart 300 mg in a 24 hour period
What is mild PREC
300
Postpartum Management
Vitals Signs, I/O, Lab values, and Pulse ox x 48hrs IV Magnesium x 48hrs HELLP syndrome may develop for the first time in the postpartum period, from a few hours up to 7 days after delivery, most occur with 48hrs
300
Definition of "high" risk CHTN
High Risk: Secondary HTN Target organ damage Previous perinatal loss Systolic > 180 or diastolic >110
300
Methods to prevent PREC... Do they work!??
Methods used to Prevent Preeclampsia High-protein and low-salt diet Calcium, magnesium, zine Fish and primrose oil Antihypertensive drugs ASA 81mg Vit C & E Heparin **studies reveal minimal to NO benefit**
300
Nifedipine: acute tx dose
10-20mg oral q 30min MAX: 50mg
400
>160/110 Proteinuria >5g in 24 hours Oliguria (<400ml in 24 hours) Cerebral visual disturbances Epigastric pain, NV Pulmonary edema Impaired liver function thrombocytopenia
What is severe PREC
400
Complications
Maternal death: 1% DIC: 15% Transfusion: 25% Elampsia: 9% Abruption: 9% Pulmonary Edema: 8% Acute renal failure: 3% Subcapsular liver hematoma: 1.5% Wound hematoma: 14%
400
Antepartum testing for low risk CHTN
Low-Risk No antihypertensive drugs Utrasound exam at 16-20 weeks Repeat at 30-32 and q 4 weeks until term
400
Drug of choice and dosing for prevention of recurrent eclamptic seizures
Magnesium Sulfate Loading dose 6 g over 15-20 min Maintenance dose of 2 g/hour 2g over 3-5 min if second seizure occurs after receiving mag
500
Convulsions or unexplained coma during pregnancy or postpartum not related to other cerebral conditions in patients with signs and symptoms of PREC
What is eclampsia
500
Anesthesia Considerations
Intermittant pain relief during labor with systemic opioids Local infiltration anesthesia for vaginal deliveries requiring repair. Pundendal Block is contraindicated due to risk of bleeding and hematoma formation Epidural is contraindicated if platelet count <75,000/mm3
500
Antepartum testing for high risk CHTN
High Risk Antihypertensive drugs US at 16-20 weeks Repeat at 28 weeks then q 3 wks until term Weekly antenatal testing starting at 28wk
500
Drug of choice and dosing for acute eclamptic seizure
Magnesium Sulfate 2 g bolus over 15-20 min