1
Q
adverse maternal outcomes with hypertensive disorders are:
A
- renal failure
- coagulopathy
- cardiac liver failure
- placental abruption
- seizures
- stroke
2
Q
chronic (pre-existing) hypertension
A
- developed before pregnancy or less than 20 weeks gestation
3
Q
gestational hypertension
A
- develops for the first time greater than 20 weeks gestation with no symptoms of preeclampsia
4
Q
- preeclampsia
A
- gestational HTN with new onset proteinuria or more adverse conditions.
5
Q
CNS conditions indicating preeclampsia
A
- severe headache/visual symptoms
6
Q
cardiorespiratory conditions indicating preeclampsia
A
- chest pain/dyspnea
- oxygen saturation less than 97%
7
Q
Hematological conditions indicating preeclampsia
A
- low platelet count
- immediate birth: platelet below 50 or transfusion of any blood product
8
Q
renal condition indicating preeclampsia
A
- elevated serum creatinine
9
Q
hepatic conditions indicating preeclampsia
A
- RUQ or epigastric pain
- elevated serum AST ALT
10
Q
uteroplacental dysfunction conditions indicating preeclampsia
A
- atypical/abnormal NST
- FGR
- oligohydramnios
- absent or reversed end-diastolic flow by umbilical artery
- angiogenic imbalance
11
Q
preeclampsia characteristics
A
- generalized vasospasm
- dysfunctional cascade of coagulation
- ‘leaky’ vessels
12
Q
risk factors of preeclampsia
A
- family history
- extreme ages
- primigravida
- multiple gestation
- diabetes
- renal disease
- obesity
13
Q
eclampsia is the onset of:
A
- seizure activity
- coma
14
Q
HELLP stands for
A
- Hemolysis (H)
- Elevated Liver enzymes (EL)
- Low Platelets (LP)
15
Q
clinical presentation of HELLP syndrome
A
- general malaise
- flu-like symptoms
- epigastric pain
16
Q
what causes endothelial dysfunction
A
- placental ischemia
17
Q
timing delivery for women with chronic hypertension
A
- delivery offered at 38-39+6 weeks gestation
18
Q
timing delivery for women with gestational hypertension
A
- when It begins before 37 weeks delivery should be around 38-39+6 weeks
- when it begins greater than 37 weeks, delivery should be immediate
19
Q
Timing delivery for women with preeclampsia
A
-
20
Q
deciding which method for induction is determined by:
A
- maternal and fetal well-being
- bishops score (position, length, consistency, effacement, and dilation of cervix)
- lab values
21
Q
first line antihypertensive drugs
A
- oral labetolol
- methydopa
- long acting oral nifedipine
- beta-blockers
22
Q
second line antihypertensives
A
- hydralazine
- clonidine
- thiazide diuretics
23
Q
antenatal corticosteroids
A
- used if preterm birth is considered within 7 days
24
Q
MgSO4 is used for
A
- prevent and treat eclamptic seizures depressing the CNS
- can be used for headaches, visual disturbances, RUQ pain, elevated liver enzymes, low platelets
25
MgSO4 dose
- 4G IV loading bolus over 20 minutes followed by 1g per hour infusion
26
side effects of MgSO4
- feeling warm, flushing, diaphoresis, blurred vision, dry mouth
- burning at IV site
27
Signs of magnesium toxicity
- absent deep tendon reflexes
- respiratory depression
- chest pain
- decreased LOC
- muscle weakness
- cardiac arrest
28
what is given for magnesium toxicity
- calcium gluconate
29
what happens when vasoconstriction occurs to the fetus
- oxygen supply is decreased
- risk for IUGR and oligohydramnios
- decreased movements, shunting blood to vital organs, decreased subcutaneous fat, polycythemia, slowed growth
30
antepartum testing includes
- fetal movement counting
- NST
- Biophysical profile
- doppler blood flow analysis
31
what is a key risk factor for placental abruption?
- maternal hypertension (pre-existing or gestational)
32
what is placental abruption or abruptio placentae?
- a partial or total separation of the placenta from the decider lining of the uterus after 20 weeks gestation
33
What are conditions associated with abruption:
- previous abruption
- cigarette smoking
- trauma
- drug use
- thrombophilia
- pre-labour rupture of membranes
34
signs and symptoms of an abruption include
- dark red vaginal bleeding
- abd/lower back pain
- uterine tenderness
- uterine contractions
- fetal distress
- hypovolemia
35
placenta previa
- placenta directly overlies the cervix
36
risk factors for placenta previa
- advance age
- multiparty
- Hx of D/C
- smoking
37
what is contraindicated when treating a women with preeclampsia having a PPH
- ergometrine
- PPH for preeclampsia is due to altered coagulation (thrombin)
38
placenta aburption characteristics
- dark red bleeding or no bleeding
- freq. uterine contractions/irritability
- pain/cramps
- fetal presentation not affected
39
placenta previa characterisitcs
- bright red bleeding
- painless
- usually no uterine activity (cause for PPH)
- malpresentation or high presenting part
40
vasa previa
- fetal vessels of the placenta lie over the cervical OS
41
placenta accreta is
- light penetration into the myometrium
42
placenta increta
- deep penetration into the myometrium
43
placenta percreta
- perforation of the uterus
44
long term effects of IUGR are:
- language problems
- learning disabilities
- hyperactivity
- attention/behavior problems
45
IUGR infants are at risk of
- perinatal asphyxia
- hypoglycaemia
- polycythemia (jaundice)
- heat loss and temp instability
- meconium aspiration
46
what are 3 signs of respiratory distress?
- grunting, nasal flaring, indrawing
NSPN 7200
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