Pregnancy Induced Hypertension – USMLE Exams

by / Sunday, 27 June 2010 / Published in OB/GYN

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Risk Factors:

1.  Nulliparity

2.  Age >40yr

3.  Family history of PIH

4.  Chronic Hypertension

5.  Chronic Renal disease

6.  Diabetes

7.  Twin Gestation

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Signs and Symptoms of Pre-eclampsia and Eclampsia:

  • Rapid Weight Gain
  • Persistent Edema unresponsive to treatment
  • Facial Swelling and upper-extremity swelling

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Pre-Eclampsia

  • Hypertension >140/90 or Systolic increase >30mmHg or Diastolic increase >15mmHg
  • New onset of proteinuria and/or Edema >0.3g/24hr
  • Occurs at greater than or equal to 20 weeks

Treatment:  Delivery

Management:  Bed Rest + Methyldopa

Severe Pre-Eclampsia

  • Systolic BP > 160 and Diastolic BP >110
  • Proteinuria >1g/24hr
  • CNS Disturbances such as: Headache, Scotomata, etc
  • Pulmonary Edema or Cyanosis
  • RUQ Pain (due to stretching of the liver capsule)

Cure:  Delivery if possible, give Magnesium Sulfate to prevent seizure.

Goals:  Get hypertension to <140/110

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Eclampsia

  • Convulsions
  • 25% occur before labor
  • 50% occur during labor
  • 25% occur in the 72hrs post-partum

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HELLP Syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets)

This is a complication of severe PIH

Signs and Symptoms:

  • RUQ Pain and Schistocytes

Treatment:

  • Delivery is the only cure
  • Transfuse blood/platelets/FFP
  • IV Fluids + Pressor agents to maintain blood pressure

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