Hypertensive Disorders in Pregnancy

All are true of Chronic Hypertension in pregnancy except

A. Diagnosed within the first 20 weeks of pregnancy
B. Does not resolve by the 12-week postpartum checkup
C. Exposure to an ACE inhibitor in the first trimester is an indication for pregnancy termination
D. Methyldopa can cause elevated liver enzymes

Not true of hypertensive disorders of pregnancy

A. Fifty percent of women diagnosed with gestational hypertension between 24 and 35 weeks develop preeclampsia
B. The preeclamptic features may appear even before the 20th week with acute polyhydramnios
C. Weight gain of more than 5 pounds a month may be the earliest evidence of preeclampsia
D. Incidence of preeclampsia in more in multigravida

Pathophysiology of preeclampsia includes all except

A. Absolute deficiency of vasodilator prostaglandin PGI2
B. Increased vascular sensitivity to the pressor agent angiotensin-II
C. Deficiency of Endothelin-1 contributes to the development of hypertension
D. Over production of antiangiogenic factors from the trophoblastic tissue

Not true of proteinuria in pregnancy

A. Albumin constitutes 50–60% and a-globulin constitutes 10–15%
B. Urine dipstick screening for proteinuria does not provide any clinical benefit and should not be used to diagnose proteinuria
C. The classic cutoff cited to define proteinuria during pregnancy is a value of >300 mg/24 hours or a urine protein-to-creatinine ratio of at least 0.3
D. The amount of proteinuria is directly related to poor maternal and neonatal outcomes

Not true of HELLP Syndrome is

A. May occur in absence of hypertension or proteinuria
B. SARS-CoV-2 infection during pregnancy have an increased risk
C. Abnormality in the levels PT, PTT, and fibrinogen
D. Helmet cells present on a peripheral blood smear

Delivery Decisions in Preeclampsia does not include

A. Induction or cesarean delivery 12 to 24 hours after corticosteroid administration
B. Prostaglandin vaginal tablet (PGE2) can be used if the cervix is not favorable
C. Vaginal delivery for fetuses younger than 30 weeks
D. In patients with HeLLP syndrome, cesarean delivery carries risks of bleeding from thrombocytopenia

In shorts

Hemolysis confirmed in HELLP syndrome

  • Hemolysis confirmed in HELLP syndrome with at least 2 of the findings:

Peripheral smear with schistocytes and burr cells,

Serum bilirubin >1.2 mg/dl,

Low serum haptoglobin(<25mg/dl) or LDH> two times the upper level of the normal,

Severe anemia with hemoglobin <8 to 10 g/dl depending on the pregnancy stage, unrelated to blood loss

Drug of choice for preventing and arresting eclamptic seizures

  • Magnesium sulfate is still the drug of choice for preventing and arresting eclamptic seizures.

  • Magnesium toxicity can lead to respiratory paralysis, central nervous system depression, and cardiac arrest. The antidote is calcium gluconate, 1 g infused intravenously over two minutes

  • Intravenous labetalol and hydralazine are commonly used for the acute management of preeclampsia.

  • Diuretics are usually contraindicated because of the already collapsed intravascular volume. However, if the pulmonary capillary wedge pressure is high, diuretics are necessary.

  • Intravenous hydration for oliguria must be given cautiously to avoid pulmonary edema, ascites and cardiopulmonary overload.

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