Hypertension Disorders Affecting Pregnancy

This flashcard set covers the various hypertensive disorders of pregnancy, including diagnostic criteria, pathophysiology, symptoms, and medical management protocols as presented by Dr. Angela Clark.

Gestational HTN

Systolic Blood Pressure (SBP) $\ge 140$ or Diastolic Blood Pressure (DBP) $\ge 90\,mmHg$ occurring after $20$ weeks of pregnancy with no proteinuria.

Preeclampsia

Increased blood pressure after $20$ weeks gestation accompanied by proteinuria, categorized as either mild or severe.

Prostacyclin

A vasodilator that is decreased in preeclampsia, allowing for vasoconstriction and reduced renal perfusion.

Mild Preeclampsia Diagnostic Criteria

SBP $\ge 140$ or DBP $\ge 90\,mmHg$ on $2$ occasions at least $4$ hours apart, with proteinuria of $> 300\,mg/24\,hrs$ or a protein/creatinine ratio $\ge 0.3$.

Severe Preeclampsia Diagnostic Criteria

SBP $\ge 160$ or DBP $\ge 110\,mmHg$ on $2$ occasions at least $4$ hours apart while on bedrest, or BP elevation with platelets $< 100,000/\mu L$, pulmonary edema, or severe epigastric pain.

Eclampsia

An obstetrical emergency characterized by grand mal seizures or coma.

HELLP Syndrome

A condition associated with severe preeclampsia involving Hemolysis, Elevated Liver enzymes, and Low Platelet count ($< 100,000$).

Chronic Hypertension

SBP $\ge 140$ or DBP $\ge 90\,mmHg$ that exists before pregnancy, before the $20^{th}$ week of gestation, or persists $6$ weeks after childbirth.

Chronic HTN with Superimposed Preeclampsia

A sudden increase in previously well-controlled BP, new or escalating proteinuria, upper body edema, or a rise in serum uric acid.

Magnesium Sulfate

Anticonvulsant therapy used in preeclampsia/eclampsia with a loading dose of $4$ or $6\,g$ IV bolus and a maintenance dose of $2\,g/hr$.

Magnesium Toxicity Signs

Decreased or absent reflexes, decreased respiratory rate, and changes in level of consciousness.

Therapeutic Magnesium Level

$4-7\,mEq/L$.

Calcium Gluconate

The agent that must be readily available as an antidote for Magnesium toxicity.

Labetalol

An IV anti-hypertensive used for acute control of severe hypertension, contraindicated in patients with asthma.

Hydralazine

An IV anti-hypertensive used for acute control ($5-10\,mg$ IV q $20$ min), contraindicated in patients with tachycardia.

Pitting Edema Grading

$1+ = 2\,mm$, $2+ = 4\,mm$, $3+ = 6\,mm$, and $4+ = 8\,mm$.

Fetal Manifestations of Preeclampsia

Includes Stillbirth, Abruption, Intrauterine Growth Restriction (IUGR), abnormal Umbilical Artery (UA) Doppler, and Oligohydramnios.

Visual Disturbances in Preeclampsia

Symptoms such as blurred vision, flashing lights, scotoma, and retinal edema caused by local vasospasms.

Glomerular Damage Sign

Indicated by the presence of proteinuria and oliguria (low urine output) due to kidney vasospasms.