lectures 3 petrenko n.v., md, phd

Hypertensive Hypertensive disorders in disorders in PregnancyPregnancy

Lectures 3Lectures 3Petrenko N.V., MD, PhDPetrenko N.V., MD, PhD

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MILD PREECLAMPSIA SEVERE PREECLAMPSIA

MATERNAL EFFECTS

Blood pressure BP reading of 140/90 mm Hg x2, 4-6 hr apart Rise to >160/110 mm Hg on two separate occasions 4-6 hr apart with pregnant woman on bed rest

Mean arterial pressure (MAP)

>105 mm Hg >105 mm Hg

Weight gain Weight gain of more than 0.5 kg/wk during the second and third trimesters or sudden weight gain of 2 kg/wk at any time

Same as mild preeclampsia

Proteinuria— Qualitative dipstick— Ouantitative 24 hr analysis

Proteinuria of 0.3 g/L in a 24 hr specimen or >0.1 g/L in a random day-time specimen on two or more occasions 6 hr apart (because protein loss is variable); with dipstick, values varying from 1+ to 2 +

Proteinuria of >0.5 g/L in 24 hr or >4+ protein on dipstick

Edema Dependent edema, some puffiness of eyes, face, fingers; pulmonary edema absent

Generalized edema, noticeable puffiness; eyes, face, fingers; pulmonary edema possibly present

Reflexes May be normal Hyperreflexia ≥3+, possible ankle clonus

PreeclampsiaPreeclampsia

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MATERNAL EFFECTS

Reflexes May be normal Hyperreflexia ≥3+, possible ankle clonus

Urine output Output matching intake, ≥30 ml/hr or <650 ml/24 hr

<20 ml/hr or <400 ml to 500 ml/24 hr

Headache Absent/transient Severe

Visual problems Absent Blurred, photophobia, blind spots on funduscopy

Irritability/changes in affect

Transient Severe

Epigastric pain Absent Present

Serum creatinine Normal Elevated

Thrombocytopenia Absent Present

AST elevation Normal or minimal Marked


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FETAL EFFECTS

Placental perfusion Reduced Decreased perfusion expressing as IUGR in fetus; FHR: late decelerations

Premature placental aging

Not apparent At birth placenta appearing smaller than normal for duration of pregnancy, premature aging apparent with numerous areas of broken syncytia, ischemic necroses (white infarcts) numerous, intervillous fibrin deposition (red infarcts)


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Lab testsLab testsNORMAL PIH HELLP

Hemoglobin/hematocrit 12 to 16 gm/dl/37% to 47%

May ↑ ↓

Platelets 150,000 to 400,000/mm3 Unchanged <100,000/mm3

PT/PTT 12 to 14 sec/60 to 70 sec Unchanged Unchanged

Fibrinogen 150 to 400 mg/dl 300 to 600 mg/dl Present

Fibrin split products (FSP) Absent Absent ↓

Blood urea nitrogen (BUN) 10 to 20 mg/dl <10 mg/dl ↑

Creatinine 0.5 to 1.1 mg/dl <1 mg/dl ↑

Lactate dehydrogenase (LDH) 45 to 90 U/L Unchanged ↑

Aspartate aminotransferase (AST) 4 to 20 U/L Unchanged ↑

Alanine aminotransferase (ALT) 3 to 21 U/L Unchanged ↑

Creatinine clearance 80 to 125 ml/min 130 to 180 ml/min ↓

Burr cells/schistocytes Absent Absent Present

Uric acid 2 to 6.6 mg/dl 4.5 to 6 mg/dl >10 mg/dl

Bilirubin (total) 0.1 to 1 mg/dl Unchanged or ↑ ↑

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EclampsiaEclampsia

Premonitory signs and symptomsPremonitory signs and symptoms HeadacheHeadache Blurred visionBlurred vision Severe epigastric painSevere epigastric pain Altered mental statusAltered mental status

Tonic- clonic convulsionsTonic- clonic convulsions HypotensionHypotension ComaComa

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Danger signDanger sign

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Thank you!Thank you!

lectures 3 petrenko n.v., md, phd

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