questions 3

Preeclampsia / Eclampsia / HELLP Syndrome

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Topic updated on 11/20/16 1:03pm

Introduction
  • Preeclampsia
    • hypertension, proteinuria, and edema
  • Eclampsia
    • preeclampsia + seizures
  • HELLP syndrome
    • form of preeclampsia with
      • Hemolysis, Elevated LFTs, Low Platelets
  • Risk factors
    • preexisting hypertension
    • maternal age of < 20 years and > 35 years
    • diabetes
    • chronic renal disease
    • autoimmune disorders
  • Typically occurs from 20 weeks gestation to 6 weeks postpartum
    • if symptoms occur before 20 weeks think molar pregnancy
  • Pathophysiology
    • placental ischemia secondary to impaired vasodilation of spiral arteries
    • results in ↑ vascular tone
      • ↑ vasoconstrictors
      • ↓ vasodilators
    • ↑ VEGF
Presentation
  • Symptoms
    • headache
    • blurred vision
    • abdominal pain
    • weight gain (water retention)
  • Physical exam
    • edema of face and extremities
    • altered mentation
    • hyperreflexia
Evaluation
  • Serology
    • thrombocytopenia
    • hyperuricemia
Treatment
  • Delivery
    • as soon as fetus is viable
  • Bed rest
  • Salt restriction
  • Monitoring and treatment of hypertension
  • IV magnesium sulfate and diazepam
    • prevention/treatment of seizures in eclampsia
Prognosis, Prevention, and Complications
  • Complications
    • maternal cerebral hemorrhage and ARDS


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Qbank (2 Questions)

TAG
(M1.RP.2) A 36-year-old primigravida woman visits her gynecologist during the 28th week of her pregnancy. Physical examination reveals pitting edema around her ankles and elevated systolic blood pressure. 24-hour urine collection yields 4 grams of protein. If left untreated, the patient is at increased risk for which of the following: Topic Review Topic

1. Urethral infection
2. Hypovolemic shock
3. Hemolysis
4. Gestational diabetes
5. Placenta accreta

PREFERRED RESPONSE ▶
TAG
(M1.RP.2) A 29-year-old G2P1 in her 22nd week of pregnancy presents with a primary complaint of peripheral edema. Her first pregnancy was without any major complications. Evaluation reveals a blood pressure of 160/90 and urinalysis demonstrates elevated levels of protein; both of these values were within normal limits at the patient's last well check-up 1 year ago. Further progression of this patient’s condition would immediately place her at greatest risk for developing which of the following? Topic Review Topic

1. Diabetes mellitus
2. Seizures
3. Myocardial infarction
4. Crohn's Disease
5. Tubulointerstitial nephritis

PREFERRED RESPONSE ▶

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