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1.
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Chronic HTN (define)
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HTN < 20 wks
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2.
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Mild vs. severe HTN
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mild: 140/90
severe: 180/110
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3.
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Why is chronic HTN bad for pregnancy? (i.e. risk factors)
(5)
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Pre-term labor
Intrauterine growth retardation (IUGR)
Fetal demise
Placental abruption
C-section
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4.
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If a patient is chronically HTN, when would you go ahead and deliver?
(4)
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1. term
2. worsening HTN, even with treatment
3. Also has preeclampsia
4. maternal or fetal compromise
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5.
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Pregnancy-induced HTN (define):
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Hypertension > 20 wks gestation
No proteinuria or edema
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6.
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How might you treat a woman with pregnancy-induced HTN?
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1. observe
2. possible lifestyle changes--slow down a little, decrease salt intake, add aspirin or calcium
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7.
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Preeclampsia (define):
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HTN
Proteinuria
Edema
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8.
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Risk factors for preeclampsia (9)
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1. nulliparity
2. old mother
3. teen mother
4. chronic HTN
5. Renal disease
6. DM
7. family hx
8. twins
9. molar pregnancy (too much placental tissue)
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9.
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How is hypertension defined for preeclampsia?
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rise in 30 systole and 15 dyastole
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10.
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How is proteinuria defined in preeclampsia?
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>300 mg over 24 hrs
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11.
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How is severe preeclampsia defined?
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180/110
Proteinuria: 5 grams (5000 mg) in 24 hrs
Oliguria: <400 cc urine in 24 hrs
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12.
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What are some symptoms of severe preeclampsia?
(3)
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Blurred vision
H/A
Epigastric pain (possible liver rupture)
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13.
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What is eclampsia?
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Preeclampsia + seizures
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14.
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What is the treatment for eclampsia?
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Magnesium sulfate (from labor to 1-2 dys after birth)
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15.
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HELLP syndrome (define)
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Hemolysis
Elevated liver function
Lowered platelets
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16.
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What are some complications that HELLP can lead to?
(3)
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DIC
placental abruption
Liver capsular rupture
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17.
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If there is bleeding in the 3rd trimester, what is the first thing you do?
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ultrasound
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18.
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What are some things you think about with third trimester bleeding?
(7)
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1. Placental abruption
2. Placenta previa
3. Vasa previa
4. Trauma
5. Rupture of membranes**
6. Infection
7. Tumor (rare)
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19.
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What is placental abruption?
Incidence?
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Edge of placenta separates
1/200 deliveries
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20.
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What are some risk factors for placental abruption?
(8)
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1. old mom
2. grand multiparity (>5 births)
3. African-American
4. Pregnancy-induced or chronic HTN
5. Premature rupture of membranes
6. Trauma
7. Smoking
8. Cocaine abuse
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21.
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What are some symptoms of placental abruption?
(5)
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1. Abdominal pain**
2. Bleeding
3. Fetal distress
4. DIC
5. Shock
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22.
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How would you treat a placental abruption?
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1. Unstable --> deliver
2. Stable, far from term --> watch it
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23.
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What is the diagnosis if the woman has painless bleeding?
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Placenta previa (placenta grows and covers the cervix)
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24.
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What are some risk factors for placenta previa?
(4)
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1. Grand multiparity
2. old mom
3. smoker
4. prior C-section
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25.
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Placenta accreta
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growth of placenta thru entire endometrium onto myometrium
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26.
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Placenta increta
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Growth of placenta into the myometrium
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27.
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Placenta percreta
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Growth of plcenta thru the myometrium onto the serosa
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28.
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Vasa previa
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Fetal vessels course over the amniotic membranes over the cervix
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