Preeclampsia

What are diagnostic criteria for gestational HTN?

140/90 without proteinuria after 20 weeks

What is the vasotensive criteria for MgSO4 intrapartum management (NNT)?

160/110 (as of 2013 by ACOG)

What are diagnostic criteria for preeclampsia with severe features?

160/110 with edema, HA, vision changes, or other preeclampsia symptoms

What is tromboxane?

A naturally occurring vasoconstrictor (Women with preeclampsia have 9x more thromboxane in pregnancy)

What is prostacyclin?

A naturally occurring vasodilator

What are fetal surveillance guidelines for altered BP (4 conditions)?

All altered conditions: daily fetal movement counts GHTN: initial and weekly NST/BPP Preeclampsia: Biweekly NST/BPP Suspected FGR: Biweekly NST/BPP Preeclampsia with severe features: daily NST/BPP

What is the antidote for MgSO4 toxicity?

Calcium gluconate

What is the preferred mode of delivery for a baby less than 30 weeks gestation in the event of preeclampsia?

Cesarean (related to fetal skull development, likelihood of labor, and presence of preeclampsia with severe features)

What indications mandate delivery in a preeclamptic woman/are contraindications to expectant management?

Eclampsia Pulmonary Edema DIC Uncontrollable, severe HTN Nonviable fetus Abnormal fetal testing Abruption

What are contraindications to expectant management of preeclampsia?

Eclampsia, PE, DIC, severe HTN, nonviable fetus, abnormal fetal testing, abruption

What is early-onset preeclampsia related to?

FGR, abnormal placentation, ischemia

How does preeclampsia affect the renal system?

HTN causes damage to the renal endothelia, causing proteinuria, decreased GFR, decreased clearance of uric acid

What is criteria for outpatient antepartum management of preeclampsia?

If BP is less than 150/100 FWB is well-established Labs WNL No severe feature s/s

How is ecclampsia treated (magnesium protocol)?

If patient is on MgSO4, then give a 2 gram "slow bolus". If patient is not then give a 6 gram bolus, followed by 2g/hour for 24 hours after the last seizure

What cardiovascular changes occur during pregnancy?

Increased CO (s/t increased blood volume) Decreased vascular resistance BP changes (drops in first trimester, returns to pre-pregnancy level by 34-36 weeks) BP drop does not occur in women who become preeclamptic

What are general management guidelines for preeclampsia <37 weeks

Labs drawn weekly Biweekly office visits BP checks at home Relative rest (not bedrest) NO urine protein

What are general management guidelines for GHTN <37 weeks?

Labs drawn weekly (at weekly office visits) BP checks at home (if stable) Relative rest (not bedrest) Daily monitoring for progressive s/s

What is the precclampsia dosage protocol for MgSO4?

Loading dose of 4-6 grams IV, then maintenance dose of 1-2 grams/hour

What is late-onset preeclampsia related to?

Maternal factors (BMI), underlying HTN, proteinuria

What are some variables affecting BP measurement?

Position of patient and arm, size of cuff, time of day (BP lower in the morning), trimester of pregnancy, instrument used (manual more accurate than automatic monitors)

What are risk factors for preeclampsia?

Primiparity, Hx of preeclampsia, AMA, excess trophoblast, macrosomia, obesity, family hx, chronic disease, infections, IVF

What are diagnostic criteria for preeclampsia?

Proteinuria after 20 weeks, BP greater than 140/90, Protein/creatinine ratio greater than .3, or 24-hour urine greater than 300 mg

How does preeclampsia affect the CNS?

Vasoconstriction and ischemia are associated with cerebral edema--seizures and CNS s/s are NOT related to severity of HTN. Manifested by hyperreflexia, HA, vision changes

What is the MOA of magnesium sulfate?

is a smooth muscle relaxant, and is intended to prevent ecclampsia, NOT to lower BP. Indicated in preeclampsia with severe features, should be considered in patients with mild preeclampsia

What are diagnostic criteria for chronic HTN in pregnancy?

140/90 before 20 weeks

What is the (theoretical) etiology of preeclampsia?

-immunological causes play a role (sperm-generated exposure: long-term exposure to the same partner is protective, whereas men who father preeclamptic pregnancies have a tendency to continue doing so) -Endothelial activation/inflammation -Genetic components -Spiral artery problems--uterine spiral arteries fail to remodel into a wider, more relaxed channel

What is a therapeutic level for MgSO4?

4-7 mEq/L

How does preeclampsia affect the cardiovascular system (on the capillary level)?

segmental vasospasm (contributing to IUGR and abruption)