Terri DelCarlo's Hypertensive (HTN) Disorders in Pregnancy Guide
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8. HTN increases the woman's risk for ___________________.
9. Preeclampsia occurs primarily after the ___________ of pregnancy, representing a great danger to the fetus & neonate. Preeclampsia contributes significantly to _______________ and __________________.
10. Causes of perinatal death related to preeclampsia death related to preeclampsia are ____________ and ___________ which lead to _____________, ______________ and _____________.
11. __________ from profound cerebral effects of preeclampsia is the major maternal hazard. As a rule, maternal & perinatal morbidity & mortality are highest when eclampsia is seen in gestations ______________, maternal age older than _______ years, the woman is a __________ and ___________ or ___________ is present.
12. The fetus of the eclamptic woman is at increased risk from __________, _____________ and _______________.
13. Causes of _______________ are ultimately __________, but could possibly be related to ____________. The presence of foreign protein (_______, _______) may trigger an adverse immunological response. This theory is supported by the _________ in _______________ (first exposure to fetal tissue) and in multips pregnant by a _____________ (different genetic material).
__________ may be an __________ disease in which the maternal antibody system is overwhelmed from _______________ in the maternal circulation (An increased incidence is seen in women exposed to a large mass of trophoblastic tissue as in twins).
_________________ may be another immunological factor. There is an _______________ among daughters and granddaughters of women with a history of ____________. This suggests an autosomal recessive gene controlling the _____________.
__________ inadequate in nutrients, especially __________ may be an etiological factor (data are inconclusive)
Pathology of Preeclampsia
The main pathogenic factor is not __________________, but poor ______________ as a result of arteriolar ___________ , arteriolar vasospasm ___________ the diameter of ___________, which impedes blood flow to all organs and ___________. Function in organs such as the ______________________ and _____________________ and can be depressed by as much as 40-60%.
___________________ results from increased sensitivity to circulating pressors, such as angiotension 2 and possibly an imbalance between 2 different types of prostaglandin.
Decreased perfusion can lead to what problems for each area below:
Placenta:
Fetus:
Kidneys:
Hypovolemia:
Liver:
Retina:
Brain:
Heart:
Lungs:
Types of hypertensive disorders:
1. Gestational HTN
The onset of ____________ without __________ after the 20th week of pregnancy. (Previously referred to as__________).
2. Transient HTN
___________ HTN with no signs of ___________ present at the time of birth & ____________ resolved by ___________. (This is a retrospective diagnosis).
3. Preeclampsia
A pregnancy-specific syndrome that usually occurs after ___________ in a previously normotensive woman. It is a multi system, __________________, disease process of _________________, characterized by ____________ and ______________.
4. Eclampsia
The occurrence of __________ in a woman with __________ that cannot be attributed to other causes.
5. Chronic HTN
HTN that is present ___________ pregnancy or that is diagnosed prior to ______________ and persists longer than 12 weeks postpartum .
6. Chronic HTN with superimposed preeclampsia
Classically: Women with HTN before 20 weeks and no proteinuria early in pregnancy- but then later in pregnancy, begin to have new onset ______________.
But also can be: a) Women with ______________ & _________ before 20 weeks.
b) Sudden ___________ in proteinuria.
c) Sudden _______ in BP of a woman whose HTN has been previously well controlled.
d)
e)
7. HELLP
HELLP is a __________ diagnosis for a variant of severe preeclampsia.
HELLP stands for ________________________________________________________________________________.
Maternal mortality is as high as __________________. Perinatal mortality can be as high as _______ per live births.
HELLP is most commonly seen in older Caucasian, multiparous women.
Signs & Symptoms of HELLP:
a) 90% of women report a history of_______________________.
b) 65% of women have ___________________.
c) 50% of women have ___________________.
d) __________ may not be elevated & may not have ________________.
e) Often _________________________________________________.
HELLP is associated with: (list 8 things)
More about preeclampsia
___________________ is often the first sign of preeclampsia.
HTN is defined as: systolic BP:_____________ Diastolic BP: _____________. (for 2 readings greater than 4-6hrs apart, but not more than one week).
Preeclampsia is divided into two categories: (defined as...)
Mild:
Severe:
Treatment for preeclampsia:
Mild: 1) NSTs at least twice per week
2) Healthy diet adequate in ______________.
3) Reduced activity & stress, but usually not complete bedrest.
Severe: 1) Consider __________________.
2) Decrease stimuli _____________________.
3) Seizure precautions: _________________________________________________________________.
4) If cervix not favorable for induction, consider _______________________________________.
5) Magnesium sulfate. Decreases risk of _______________. May indirectly ___________________ because of smooth muscle relaxation.
6) Antihypertensive meds: Hydralazine (Apresoline) acts as an arteriolar ___________________________.
7) Labetalol: A beta-blocking agent causing ________________________________.
8) Aldomet: Decreases __________________. Causes _________________________.
9) Nifedipine: _________________ channel blocker, which causes relaxation of ________________ (blood vessels are compromised of _________________ (blood vessels are comprised of smooth muscle).