Obstetrics 2: Hypertensive Complications in Pregnancy

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Questions and Answers

Which of the following disorders is characterized by hypertension that develops after 20 weeks of gestation and resolves after delivery?

Preeclampsia with Severe Features

Gestational Hypertension (correct)

Chronic Hypertension

Eclampsia

Which classification system is most commonly used for hypertensive disorders in pregnancy?

Seattle classification

Oregon classification

Tennessee classification (correct)

Mississippi classification

What is a significant feature of Superimposed Preeclampsia with Severe Features?

It is usually mild and self-resolving.

It primarily affects the mother's mental health.

It can lead to serious complications like HELLP syndrome. (correct)

It occurs without any underlying chronic condition.

Which of the following statements about Eclampsia is true?

It is characterized by seizures that occur during pregnancy or shortly after delivery. Signup and view all the answers

Which of the following disorders includes features that may lead to liver failure and thrombocytopenia?

HELLP Syndrome Signup and view all the answers

What primarily differentiates Preeclampsia from Chronic Hypertension?

The timing of onset relative to gestation. Signup and view all the answers

Which complication is commonly associated with Severe Preeclampsia?

Placental Abruption Signup and view all the answers

Which organ system is most affected by Hypertensive Disorders in pregnancy?

Renal system Signup and view all the answers

What percentage of pregnant women are estimated to develop chronic hypertension?

1-5% Signup and view all the answers

What blood pressure reading must be present prior to 20 weeks to indicate chronic hypertension?

140/90 Signup and view all the answers

What is the primary treatment for managing hypertension in pregnant patients?

Oral antihypertensive medication Signup and view all the answers

What type of hypertension predominantly occurs in pregnant women with chronic hypertension?

Essential Hypertension Signup and view all the answers

Which of the following is NOT a potential underlying cause of secondary hypertension?

Genetics Signup and view all the answers

What medication is commonly used to prevent seizures in pregnant women with hypertension?

Magnesium Sulfate Signup and view all the answers

Which of the following factors contributes to the development of chronic hypertension?

Genetics and environment Signup and view all the answers

What is the importance of assessing a patient's history of hypertension before pregnancy?

To evaluate the course of hypertension management Signup and view all the answers

What is the most plausible diagnosis for a patient with a blood pressure of 150/90 mmHg and no evidence of protein spillage in urine?

Gestational hypertension Signup and view all the answers

What is the purpose of administering magnesium sulfate in a pregnancy setting?

To achieve anticonvulsant effect Signup and view all the answers

Which level of magnesium sulfate in the blood is associated with respiratory arrest?

12 mEq/L or more Signup and view all the answers

What might occur if magnesium sulfate levels reach 10 mEq/L?

Loss of patellar reflex Signup and view all the answers

What is a key indicator of uteroplacental perfusion issues?

Fetal growth restriction Signup and view all the answers

What is the administration purpose of dexamethasone in postpartum women with HELLP syndrome?

Decrease incidence of renal failure Signup and view all the answers

A patient at 27 weeks AOG with severe headache and high blood pressure is likely experiencing what?

Preeclampsia Signup and view all the answers

What is an appropriate management step for a patient presenting with high blood pressure and altered fetal heart tones?

Magnesium sulfate and phenytoin Signup and view all the answers

What is the blood pressure threshold that defines pre-eclampsia?

≥ 140/90 mmHg Signup and view all the answers

What is necessary for diagnosing pre-eclampsia besides elevated blood pressure?

Proteinuria Signup and view all the answers

Which of the following medications is contraindicated in pregnant women due to teratogenic effects?

Phenytoin Signup and view all the answers

What does HELLP syndrome stand for?

Hemolysis, elevated liver enzymes, low platelet count Signup and view all the answers

What role does magnesium sulfate play in the management of severe hypertension in pregnant women?

It's used to prevent convulsions. Signup and view all the answers

What is a common classification used to diagnose HELLP syndrome?

Tennessee classification Signup and view all the answers

What constitutes the laboratory findings for a diagnosis of HELLP syndrome?

LDH > 600 IU/L or bilirubin ≥ 1.2 mg/dL Signup and view all the answers

What is NOT a criterion for diagnosing pre-eclampsia?

Fetal growth restriction Signup and view all the answers

What is the probable plasma magnesium level (mEq/L) of a patient who lost her patellar reflexes but does not exhibit respiratory depression?

8-9 Signup and view all the answers

At what age of gestation (AOG) in weeks does pregnancy-induced hypertension typically appear the earliest?

18 Signup and view all the answers

In a patient with a high blood pressure reading of 200/120 mmHg and blurred vision, what is the most appropriate management?

Refer to a hospital for delivery Signup and view all the answers

What defines chronic hypertension in the context of pregnancy?

Blood pressure of ≥ 140/90 mmHg prior to 20 weeks AOG Signup and view all the answers

What is a key use of magnesium sulfate in pregnant patients?

As an anticonvulsant and neuroprotective agent Signup and view all the answers

What is the loading dose of magnesium sulfate typically given in severe pre-eclampsia?

4g IV Signup and view all the answers

Which statement correctly differentiates gestational hypertension from chronic hypertension?

Chronic hypertension precedes the pregnancy with historically elevated BP Signup and view all the answers

What is the recommended follow-up for a patient receiving magnesium sulfate postpartum?

Continuous monitoring for 24 hours Signup and view all the answers

Study Notes

Hypertensive Complications in Pregnancy Overview

Hypertensive disorders affect 5–10% of pregnancies.
Include a spectrum of conditions from chronic hypertension to severe preeclampsia.

Diagnosis of Hypertensive Disorders

Chronic hypertension (CHTN) is defined as blood pressure ≥ 140/90 mmHg prior to 20 weeks of gestation.
Gestational hypertension occurs after 20 weeks with sustained BP ≥ 140/90 mmHg without proteinuria.
Preeclampsia involves hypertension with proteinuria after 20 weeks.

Types of Hypertensive Disorders

Chronic Hypertension (CHTN): History of hypertension before pregnancy.
Gestational Hypertension: New onset hypertension after 20 weeks.
Preeclampsia without Severe Features: Hypertension with proteinuria but no severe manifestations.
Superimposed Preeclampsia: Development of preeclampsia in women with existing hypertension.
Preeclampsia with Severe Features: Defined by specific criteria such as severe BP elevations or end-organ dysfunction.
HELLP Syndrome: Characterized by hemolysis, elevated liver enzymes, and low platelet count.
Eclampsia: The occurrence of seizures in a patient with preeclampsia.

Etiopathogenesis of Hypertensive Disorders

Chronic hypertension is often a primary condition, where 90% of cases are essential hypertension.
Can be influenced by genetics and environmental factors.

Clinical Management

Management may include oral antihypertensive medications in outpatient settings.
Magnesium sulfate is used for seizure prophylaxis in severe cases.
Monitor magnesium sulfate levels to avoid respiratory depression, aiming for 4-7 mEq/L.

Prediction and Prevention

Low-dose aspirin may help prevent hypertensive disorders in high-risk women.
Routine monitoring of BP is essential in pregnant patients.

Disturbances in Organ Systems

Hypertensive conditions can impact various organs, leading to increased morbidity and mortality.
Uteroplacental perfusion issues may result in fetal growth restrictions.

Dexamethasone Administration in HELLP Syndrome

Aimed to decrease renal failure incidence post-partum.

Common Clinical Scenarios

Severe headache and elevated BP in pregnancy may indicate severe hypertension needing immediate management.
A patient losing patellar reflexes on magnesium sulfate may have plasma levels between 10-11 mEq/L.

Management Guidelines for Specific Cases

For patients with severe preeclampsia, magnesium sulfate is a preferred treatment to prevent seizures.
If a patient exhibits blurring vision and epigastric pain with high BP, management includes serial CBC and liver enzyme checks.

Important Classifications

Tennessee Classification for HELLP Syndrome:
- Requires abnormal peripheral smear, elevated LDH or bilirubin, and elevated liver enzymes.
Recognize that essential hypertension is defined as hypertension not secondary to other conditions.

Key Takeaways

Close monitoring and timely interventions are critical in managing hypertensive disorders during pregnancy.
Understanding and recognizing the signs and symptoms of each condition can lead to better maternal and fetal outcomes.

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Description

This quiz focuses on hypertensive complications that can arise during pregnancy, as covered in the Obstetrics 2 course. It aims to assess knowledge and understanding of these conditions and their management. Designed for medical students and professionals, this material is crucial for providing safe maternal care.