antepartum - hypertensive, diabetes, multiples

when is gestational hypertension diagnoses

after 20 weeks

gestation hypertension diagnosis criteria

• BP >140/90 on 2 occasions

• no proteinuria or end organ damage

preeclampsia diagnostic criteria

• HTN and proteinuria

• or HTN and end organ features

preeclampsia BP

>140/90 on two occasions 4 hours apart

preeclampsia proteinuria

• >300 mg/24 hrs

• proteinuria:creatinine; >0.3 ration

preeclampsia end organ failure

• platelets <100,000

• serum creatinine >1.1

• liver enzymes >2x normal

• pulmonary edema

• visual or cerebral symptoms

preeclampsia assessment

• BP monitoring

• oliguria: danger sign

• neurologic: 3,4+ reflexes

• epigastric or RUQ pain

• signs of abruption; vaginal bleeding, uterine pain

preeclampsia treatment

• severe: induction

• antihypertensives (labetelol)

• magnesium sulfate

magnesium sulfate loading dose

4-6 g IV 15-30 mins

magnesium sulfate maintenance dose

1-3 g/hr

magnesium sulfate therapeutic range

4-7 meq/L

magnesium sulfate monitoring

• RR >12 breaths/min

• urine output >30

• deep tendon reflexes present

magnesium sulfate antidote

calcium gluconate

HELLP syndrome is

hemolysis, elevated liver enzymes, low platelets

HELLP syndrome requires

delivery regardless of gestational age, life threatening

risks/signs of HELLP syndrome

• RUQ tenderness

• placental abruption

• DIC

eclampsia is

preeclampisia and new onset tonic seizures w/ no other cause

gestation diabetes mellitus causes

• hCS causes insulin resistance

• pancreas can’t keep up

GDM screening

• 24-28 weeks

• type 1 and 2 closely monitored

GDM testing

• 1 hr OGTTG, 3 hr to diagnose

• <130 good

• 180 is diabetic

GDM risks

• shoulder dystocia

• still birth

• preterm birth

• polyhydramnios

GDM treatment

• class a1

  • diet and exercise

• class a2

  • insulin preferred

  • metformin/glyburide

GDM delivery

• well controlled

  • induction 39-40 weeks

• poorly controlled

  • monitored/early deliver

• c section might be needed

multiple gestation dizygotic (fraternal)

• 2 eggs fertilized

• dichorionic/diamniotic

• low risk

multiple gestation monozygotic (identical)

• 1 egg split

• earlier the split the lower the risk

• mono/mono

• cord entanglement risk, twin to twin transfusion