Midterm:NU661 Primary Care Childbearing Woman
Midterm Exam latest Fall Spring Semester 2024.2025
Verified Exam (RECOMMENDED)
Causes of Secondary HTN - ANSWER: -Renal: Glomerular disease, polycystic kidneys,
renal artery stenosis
-Collagen Vascular Disease: scleroderma, SLE, periarteritis nodosa
-Endcrinopathy: DM, thyrotoxicosis, hyperaldosteronism, Cushing's Disease,
pheochromocytoma
-Vascular disease: Coarctation, vasculitis
Gestational HTN - ANSWER: -Dx'd after 20th week gestation
-No proteinuria
(Note: this terminology replaces "Pregnancy Induced Hypertension as of year 2000)
Pre-eclampsia - ANSWER: -Elevated BP with proteinuria and/or edema
-Eclampsia
-HELLP
-Other severe pre-eclampsia
Chronic HTN (in pregnancy) - ANSWER: -Dx'd prior to 20th week gestation
-Elevated BP prior to conception
BP In Pregnancy - ANSWER: -Decreases normally in 2nd trimester, returns to pre-
pregnancy level in 3rd trimester
-Mild HTN in pregnancy: 140-179/90-109
-Severe HTN in pregnancy: >/= 180/110
Perinatal Risks of Chronic HTN in Pregnancy - ANSWER: -PTL (66% chance of PTB)
-Pre-eclampsia
-Abruption
-IUGR (30% chance)
-Fetal demise
-C-section delivery
End Organ Evaluation - ANSWER: -EKG
-24 hour urine collection for proteinuria
-Ophthalmic evaluation
-Renal disease results in worse prognosis (GFR, BUN, Creatinine)
Management of Mild HTN in Pregnancy - ANSWER: -Most do fine w/o medications
-One RCT showed no decrease in IUGR, abruption, superimposed HTN or perinatal
mortality (Tx'd by placebo, Aldomet, Labetolol)
HTN Medications Used in Pregnancy - ANSWER: -ACE-Inhibitors
-Aldomet
,-Labetolol
-Nifedipine
-Diuretics
Antenatal Management of HTN in Pregnancy - ANSWER: Pre-Pregnancy:
-ID secondary cause (if present)
-Switch to safe meds PRN
Antenatal:
-Baseline LFTs, CBC, BUN, Creatinine
-Baseline 24hr urine for protein, creatinine clearance
-2nd trimester visits q2weeks
-3rd trimester visits q weekly
-Baseline U/S 18-20 weeks, then q4weeks for EFW, AFI, doppler studies
-Weekly NST beginning 32 weeks
-Deliver by 39weeks
(Note: No consensus on management)
Pharmacologic:
-Keep BP </=140/90
-Aldomet, Nifedipine, Labetolol
-Watch for superimposed HTN and aggressively treat
Aldomet - ANSWER: -Most popular anti-HTN used in pregnancy
-Centrally acting: reduces sympathetic outflow by stimulating a2-adrenoreceptor
-Reduces systemic vascular resistance w/o effecting Cardiac Output
-S/Es: Dry mouth, lethargy, LFT changes, postural hypotension
-Dosage: 1gm loading dose, then up to 3gm in divided doses
-Limited effects on uteroplacental flow
-Safety data present for pregnancy and breastfeeding
Labetolol - ANSWER: -Chronic and/or gestational HTN management
-Beta-blocker with some alpha action
-Good for pre-eclampsia d/t alpha action that helps reduce vasospasm
-S/Es: HA, tremor
-No growth restrictive effects
-Dose: 300mg/day, up to 2400mg/day
-No difference in outcomes compared to aldomet
-Safety data present for pregnancy and breastfeeding
Nifedipine - ANSWER: -Calcium-channel blocker
-S/Es: HA, flushing, palpitations
-No adverse fetal effects
-Dose: 20-30mg TID or QID
-Safe in pregnancy/breastfeeding
ACE-Inhibitors and Diuretics in Pregnancy - ANSWER: -Not commonly used
ACE-Inhibitors contraindicated 1st trimester d/t:
-fetal renal failure
,-oligohydramnios
-IUGR
-fetal pulmonary hypoplasia
-fetal demise
-neonatal renal failure and death
Diuretics: not recommended d/t the needed increase in blood volume in pregnancy
as these would counteract that effect
Magnesium Sulfate - ANSWER: -Treat and prevent eclamptic seizures
-Most women with HTN in pregnancy tx'd with this
-Anti-epileptic
-Safe wide therapeutic range
-Rapid onset (IV thru pump)
-Reliable, predictable duration
-Non-toxic to mother and baby (but must closely monitor serum levels)
-simple to administer
-Provider comfort
Magnesium Sulfate Toxicity - ANSWER: Presentation:
-Loss of DTRs: 8-12mg/dL
-Somnolence: 10-12mg/dL
-Muscular Paralysis: 15-17mg/dL
-Respiratory Difficulty: 15-17mg/dL
-Cardiac Arrest: 30-35mg/dL
Antidote: calcium gluconate 1gm over 3 minutes
Mechanical ventilation PRN
-Toxicity rarely occurs, usually d/t renal impairment (someone w/normal urinary
output unlikely to get toxic); monitor levels, <9, some sxs can occur when >6; give on
pump; urinary output >/=30ml/hr (Foley best was to measure); know baseline
creatinine
Delivery Considerations with Gestational HTN - ANSWER: -Hydralazine, labetolol can
be given (less often than MgSO4)
-Vaginal delivery safer for mom d/t coagulopathies and fluid balance
-Vaginal delivery even after eclamptic seizure (usually try to wait 12-24hrs after, then
induce labor)
-C-Section only as per normal (e.g. breech, CPD)
Reoccurance of Gestational HTN - ANSWER: -25-60% reoccurrance in subsequent
pregnancies
-Usually less severe in subsequent pregnancies
-Severe: 45-50% especially if occurred early in gestation
-HELLP reoccurance: 2-19%
-Pre-eclampsia does not predispose women to chronic HTN but may indicate a
propensity towards it
Pre-Eclampsia - ANSWER: -HTN (150-160/100-110)
, -Proteinuria (100mg/L in random, 300mg/L in 24hr, 3+ on dipstick)
-Edema (clinical evidence of swelling in non-dependent areas (typically in face), fluid
retention evident by rapid wt gain (5lb+/wk)
-Sxs: HA, visual changes (e.g.blurred vision, epigastric pain)
Pt does not have to have ALL of these to be dx/d
S/S Severe Pre-eclampsia - ANSWER: -BP >/= 160/110
-Proteinuria: 5gr/24hr, 3-4+ on dipstick
-Oliguria: <500cc/24hrs
-HA/scotomas
-Pulmonary edema/cyanosis
-Elevated LFTs
-Thrombocytopenia <100,000 or elevated LDH
-Increased serum creatinine
-Epigastric pain
-IUGR
HELLP Syndrome - ANSWER: -Form of pre-eclampsia
-Hemolysis, Elevated Liver function tests, Low Platelets
-20% of women with severe pre-eclampsia
Superimposed Pre-eclampsia - ANSWER: -New onset of proteinuria w/chronic HTN
OR
-Sudden increase in proteinuria or BP in pt with chronic HTN
Eclampsia - ANSWER: -Seizure or coma in pregnant woman who exhibited S/S of Pre-
eclampsia
-15% no prodrome
-50% antepartum
-25% Intrapartum (during labor and delivery)
-25% Postpartum (rare), usually w/in 48 hours of delivery but can occur up to two
weeks after delivery
-20% do not have proteinuria
-32% have no edema
-20% relatively hypertensive
-Maternal mortality rate 1-14% worldwide
Risk Factors in Pre-eclampsia - ANSWER: -Nulliparity
-AMA
-Chronic HTN
-Renal problems
-Multiple gestation
-Pregestational DM
-IUGR
-Family hx
-Hx of PIH in previous pregnancy
-Antiphospholipid syndrome
Midterm Exam latest Fall Spring Semester 2024.2025
Verified Exam (RECOMMENDED)
Causes of Secondary HTN - ANSWER: -Renal: Glomerular disease, polycystic kidneys,
renal artery stenosis
-Collagen Vascular Disease: scleroderma, SLE, periarteritis nodosa
-Endcrinopathy: DM, thyrotoxicosis, hyperaldosteronism, Cushing's Disease,
pheochromocytoma
-Vascular disease: Coarctation, vasculitis
Gestational HTN - ANSWER: -Dx'd after 20th week gestation
-No proteinuria
(Note: this terminology replaces "Pregnancy Induced Hypertension as of year 2000)
Pre-eclampsia - ANSWER: -Elevated BP with proteinuria and/or edema
-Eclampsia
-HELLP
-Other severe pre-eclampsia
Chronic HTN (in pregnancy) - ANSWER: -Dx'd prior to 20th week gestation
-Elevated BP prior to conception
BP In Pregnancy - ANSWER: -Decreases normally in 2nd trimester, returns to pre-
pregnancy level in 3rd trimester
-Mild HTN in pregnancy: 140-179/90-109
-Severe HTN in pregnancy: >/= 180/110
Perinatal Risks of Chronic HTN in Pregnancy - ANSWER: -PTL (66% chance of PTB)
-Pre-eclampsia
-Abruption
-IUGR (30% chance)
-Fetal demise
-C-section delivery
End Organ Evaluation - ANSWER: -EKG
-24 hour urine collection for proteinuria
-Ophthalmic evaluation
-Renal disease results in worse prognosis (GFR, BUN, Creatinine)
Management of Mild HTN in Pregnancy - ANSWER: -Most do fine w/o medications
-One RCT showed no decrease in IUGR, abruption, superimposed HTN or perinatal
mortality (Tx'd by placebo, Aldomet, Labetolol)
HTN Medications Used in Pregnancy - ANSWER: -ACE-Inhibitors
-Aldomet
,-Labetolol
-Nifedipine
-Diuretics
Antenatal Management of HTN in Pregnancy - ANSWER: Pre-Pregnancy:
-ID secondary cause (if present)
-Switch to safe meds PRN
Antenatal:
-Baseline LFTs, CBC, BUN, Creatinine
-Baseline 24hr urine for protein, creatinine clearance
-2nd trimester visits q2weeks
-3rd trimester visits q weekly
-Baseline U/S 18-20 weeks, then q4weeks for EFW, AFI, doppler studies
-Weekly NST beginning 32 weeks
-Deliver by 39weeks
(Note: No consensus on management)
Pharmacologic:
-Keep BP </=140/90
-Aldomet, Nifedipine, Labetolol
-Watch for superimposed HTN and aggressively treat
Aldomet - ANSWER: -Most popular anti-HTN used in pregnancy
-Centrally acting: reduces sympathetic outflow by stimulating a2-adrenoreceptor
-Reduces systemic vascular resistance w/o effecting Cardiac Output
-S/Es: Dry mouth, lethargy, LFT changes, postural hypotension
-Dosage: 1gm loading dose, then up to 3gm in divided doses
-Limited effects on uteroplacental flow
-Safety data present for pregnancy and breastfeeding
Labetolol - ANSWER: -Chronic and/or gestational HTN management
-Beta-blocker with some alpha action
-Good for pre-eclampsia d/t alpha action that helps reduce vasospasm
-S/Es: HA, tremor
-No growth restrictive effects
-Dose: 300mg/day, up to 2400mg/day
-No difference in outcomes compared to aldomet
-Safety data present for pregnancy and breastfeeding
Nifedipine - ANSWER: -Calcium-channel blocker
-S/Es: HA, flushing, palpitations
-No adverse fetal effects
-Dose: 20-30mg TID or QID
-Safe in pregnancy/breastfeeding
ACE-Inhibitors and Diuretics in Pregnancy - ANSWER: -Not commonly used
ACE-Inhibitors contraindicated 1st trimester d/t:
-fetal renal failure
,-oligohydramnios
-IUGR
-fetal pulmonary hypoplasia
-fetal demise
-neonatal renal failure and death
Diuretics: not recommended d/t the needed increase in blood volume in pregnancy
as these would counteract that effect
Magnesium Sulfate - ANSWER: -Treat and prevent eclamptic seizures
-Most women with HTN in pregnancy tx'd with this
-Anti-epileptic
-Safe wide therapeutic range
-Rapid onset (IV thru pump)
-Reliable, predictable duration
-Non-toxic to mother and baby (but must closely monitor serum levels)
-simple to administer
-Provider comfort
Magnesium Sulfate Toxicity - ANSWER: Presentation:
-Loss of DTRs: 8-12mg/dL
-Somnolence: 10-12mg/dL
-Muscular Paralysis: 15-17mg/dL
-Respiratory Difficulty: 15-17mg/dL
-Cardiac Arrest: 30-35mg/dL
Antidote: calcium gluconate 1gm over 3 minutes
Mechanical ventilation PRN
-Toxicity rarely occurs, usually d/t renal impairment (someone w/normal urinary
output unlikely to get toxic); monitor levels, <9, some sxs can occur when >6; give on
pump; urinary output >/=30ml/hr (Foley best was to measure); know baseline
creatinine
Delivery Considerations with Gestational HTN - ANSWER: -Hydralazine, labetolol can
be given (less often than MgSO4)
-Vaginal delivery safer for mom d/t coagulopathies and fluid balance
-Vaginal delivery even after eclamptic seizure (usually try to wait 12-24hrs after, then
induce labor)
-C-Section only as per normal (e.g. breech, CPD)
Reoccurance of Gestational HTN - ANSWER: -25-60% reoccurrance in subsequent
pregnancies
-Usually less severe in subsequent pregnancies
-Severe: 45-50% especially if occurred early in gestation
-HELLP reoccurance: 2-19%
-Pre-eclampsia does not predispose women to chronic HTN but may indicate a
propensity towards it
Pre-Eclampsia - ANSWER: -HTN (150-160/100-110)
, -Proteinuria (100mg/L in random, 300mg/L in 24hr, 3+ on dipstick)
-Edema (clinical evidence of swelling in non-dependent areas (typically in face), fluid
retention evident by rapid wt gain (5lb+/wk)
-Sxs: HA, visual changes (e.g.blurred vision, epigastric pain)
Pt does not have to have ALL of these to be dx/d
S/S Severe Pre-eclampsia - ANSWER: -BP >/= 160/110
-Proteinuria: 5gr/24hr, 3-4+ on dipstick
-Oliguria: <500cc/24hrs
-HA/scotomas
-Pulmonary edema/cyanosis
-Elevated LFTs
-Thrombocytopenia <100,000 or elevated LDH
-Increased serum creatinine
-Epigastric pain
-IUGR
HELLP Syndrome - ANSWER: -Form of pre-eclampsia
-Hemolysis, Elevated Liver function tests, Low Platelets
-20% of women with severe pre-eclampsia
Superimposed Pre-eclampsia - ANSWER: -New onset of proteinuria w/chronic HTN
OR
-Sudden increase in proteinuria or BP in pt with chronic HTN
Eclampsia - ANSWER: -Seizure or coma in pregnant woman who exhibited S/S of Pre-
eclampsia
-15% no prodrome
-50% antepartum
-25% Intrapartum (during labor and delivery)
-25% Postpartum (rare), usually w/in 48 hours of delivery but can occur up to two
weeks after delivery
-20% do not have proteinuria
-32% have no edema
-20% relatively hypertensive
-Maternal mortality rate 1-14% worldwide
Risk Factors in Pre-eclampsia - ANSWER: -Nulliparity
-AMA
-Chronic HTN
-Renal problems
-Multiple gestation
-Pregestational DM
-IUGR
-Family hx
-Hx of PIH in previous pregnancy
-Antiphospholipid syndrome
