What is gestational HTN
Onset of HTN after 20 weeks
If left untreated or even if treated, gestational HTN may progress to __
Preeclampsia
how is Preeclampsia-eclampsia diagnosed?
- Systolic greater than 140 and/or a diastolic of 90 or higher on two occasions at least 4 hours apart and after 20 weeks
- With or without proteinuria
- Or severe HTN after 20 weeks ( sys at or above 160 and/or a dia at or above 110)
What are the qualifications for proteinuria?
300mg or more in a 24 hours collection or a random urine dipstick test of 1+ or higher)
-Protein to creatinine ratio of 0.3mg
What is eclampsia?
WHen preeclampsia progresses into a generalized seizure
What is defined as chronic HTN for a pregnant woman?
HTN before pregnancy, DX before 20 weeks, or continuing beyond 12 weeks PP
How is superimposed (over chronic HTN) preeclampsia determined?
- Onset of proteinuria after 20 weeks
- Increase in pre-existing proteinuria
- sudden exacerbation of controlled HTN
- Change in labs (Plate less than 100K, Elevated LFT, decreased renal function)
- Development of HA, Epigastric pain, or visual changes
What is the only known cure for preeclampsia?
Birth
What is the Initial patho of preeclampsia?
- Generalized VC
- Vasospasms
What is the current theory as to why preeclampsia happens?
- Begins during placental formation
- Abnormal development in maternal spiral ateries leads to decreased perfusion and oxygenation
- Diminished perfusion leads to a release of placental micro-particles that cause a systemic inflammatory response
A woman may have HELLP syndrome and be absent of ___. if she does she still is considered to have ____
HTN
Preeclampsia
Normotensive woman should be considered to have preeclampsia if she has___
Other signs of reduced organ perfusion
During treatment of preeclampsia, why is fluid replacement monitored and managed
To avoid worsening the womans’ reduced intravascular volume without giving her too much that would cause pulmonary edema or ascites
What type of birth is prefered for a preeclamptic mother? Why?
Induced vaginal
-To avoid bleeding and clotting that comes with c-sections
What are the three main effects of preeclampsia on the CV/pulmonary system?
- Increased vascular resistance
- Increased Cardiac output and stroke volume
- Decreased colloid osmotic pressure
Describe how preeclampsia affects the CV and Pulmonary system
- Increased sensitivity to angiotensin causes an increase in BP via vasoconstriction.
- As BP rises, so does CO and SV creating increased vascular resistance
- This raise in Vascular resistance causes excess permeability of capillaries and in turn, will decrease plasma volume and edema will occur (especially in the lungs)
What are the three main effects of preeclampsia on the hematologic system?
- Thrombocytopenia (deficiency of platelets)
- Altered platelet function
- Hemolysis
Describe how preeclampsia affects the hematologic system
- hemoconcentration occurs d/t loss of plasma volume, this increased the viscosity of the blood.
- The increased viscosity causes hemolysis in the microvasculature and platelet clumping
- The clumping damages the platelets as well as endothelial cells leading to reduced platelets and an increased in thromboxane A (TXA) (altered Thromboxane: Prostacyclin ratio)
- Thromboxane A causes vasoconstriction and platelet aggregation this continuing the process when it is elevated
What are the 3 main effects of preeclampsia on the neurological system?
- Hyperreflexia
- Headache
- Seizure (eclampsia)
Describe how preeclampsia affects the neurological system
- The vasoconstriction and vasospasms cause ruptures in the small capillaries in the cerebral vasculature
- These ruptures cause small hemorrhages that eventually cause cerebral edema
- This cerebral edema causes headaches and hyperreflexia
- If it continues, seizures will occur
What are the two major effects of preeclampsia on the renal system?
- proteinuria
2. Altered function
Describe how preeclampsia affects the renal system
- Decreased glomerular blood flow from the HTN causes damage to the glomeruli
- This damage alters the function of the filtration and allows for protein to be lost through the urine (proteinuria) as well as causing an increased BUN, creatinine and uric acid
- When the protein leaves colloid osmotic pressure decreases causing edema
- When the edema occurs, hypovolemia occurs as well. This increases the viscosity of the blood and triggers angiotensin/aldosterone thus furthering the pathology
What are the two main effects of preeclampsia on the hepatic system?
- Hepatic dysfunction
2. Hepatic rupture
Describe how preeclampsia affects the hepatic system
-Hepatic function is altered as vascular resistance and inflammation occurs and hepatic edema occurs
-This eventually leads to a subcapsular hematoma
-This causes increased liver enzymes and epigastric pain
(HELLP SYNDROME)
-
Week 1 intrapartum assessment63
-
Week 1 Process of Labor124
-
Week 1 Pain Management during labor86
-
Week 1 Fetal Heart Monitoring38
-
Week 2 Augmentation of labor61
-
Week 2 Operative Birth39
-
Week 2 Postpartum114
-
Newborn Adaptation63
-
Newborn Assessment51
-
Week 4 Conception and Prenatal Development81
-
Week 4 maternal adaptation during preg88
-
Week 4 Fetal Assessment99
-
High Risk Preg63
-
Eclampsia49
