HYPERTENSIVE DISORDERS OBSTETRICS II | MIDTERMS (1st Sem)

Dr. Daisy Dulnuan

OUTLINE  High blood pressure at 18 weeks, but went for

I. HYPERTENSIVE DISORDERS checkup at 25 weeks
A. Terminology and Diagnosis  Ask for urine protein, if (+)  preeclampsia
II. PREECLAMPSIA
A. Risk factors  Chronic/gestational
B. Etiology (History: Hypertension prior to pregnancy or HTN
C. Potential Causes in prior pregnancies of not first pregnancy)
D. Pathogenesis
E. Pathophysiology
F. Management  Superimposed Preeclampsia on Chronic Hypertension
G. Prevention o Women with hypertension only in early gestation who
H. Main Objectives in the Management of Severe develop proteinuria after 20 weeks of gestation
Preeclampsia o Women with hypertension and proteinuria before 20 weeks
I. Complications of Prematurity
J. An Algorithm in the Expectant Management of Severe of gestation with:
Preeclampsia Remote From Term (<34 weeks)  Sudden exacerbation of hypertension
K. Maternal Evauation  Platelet count < 100,000
L. Fetal Evaluation  Elevated liver enzymes
M. What is the Mode of Delivery
N. How is Postpartum Hypertension Managed?
 Creatinine level > 1.1 mg/dL
O. Severe Preeclampsia <24 weeks  Pulmonary edema
P. How does Severe Preeclampsia Differ From Preeclampsia  RUQ pain/severe headaches
Without Severe Features and Gestational Hypertension?  Substantial increase in proteinuria
 Blurring of vision
I. HYPERTENSIVE DISORDERS
 Complicates 5-10% of all pregnancies (globally) 2-5% (locally) II. PREECLAMPSIA
 16% of all maternal death - World Health Organization  “TRELICEP”
 2nd most common cause of maternal death o Thrombocytopenia: Platelet count <100,000/mL
 One of the deadly triad – along with hemorrhage and infection o Renal Insufficiency: Creatinine >1.1 mg/dL or doubling of
 Affects multiple organ the creatine
 Preeclampsia syndrome o Liver Impairment: Liver enzymes 2x normal value
o (alone or with superimposed chronic hypertension) - o Cerebral or Vascular Symptoms
most dangerous o Pulmonary Edema
 Gestational hypertension
o New-onset hypertension during pregnancy is followed by  New criteria for Preeclampsia:
signs and symptoms of preeclampsia almost half the o With or without proteinuria but with one or more of the
time following criteria above.
 Classification of Hypertensive Disorders complicating  Preeclampsia is divided into:
pregnancy: a) Preeclampsia with non-severe features
o Gestational Hypertension b) Preeclampsia with severe features
o Preeclampsia
o Eclampsia
o Chronic Hypertension
o Superimposed Preeclampsia on Chronic Hypertension

A. TERMINOLOGY AND DIAGNOSIS

 Gestational Hypertension
o BP ≥140/90 mmHg for the first time during pregancy
after 20 weeks
o No proteinuria
o BP returns to normal within 12 weeks after delivery
o Older books - transient htn
o Vs preeclampsia - (+) Proteinuria
 Proteinuria
o 300 mg/24hr urine sample
o Dipstick (+) If:
o Urine protein/crea ratio - 0.3 mg/dL  BP = 160/100, normal labs
 Eclampsia  Preeclampsia with non-severe features
o Seizures that cannot be attributed to other causes in a  BP = 160/120, normal labs
women with preeclampsia  Preeclampsia with severe features (regardless of (-)
o Hx taking: prior hx of seizure prior getting pregnant albumin and normal labs, look at the BP)
o BP <140/90 w/ no hx - consider as eclampsia unless  BP = 140/90 with headache or any elevated labs
proven otherwise  Preeclampsia with severe features
 Chronic Hypertension  BP = ≥160/110 but with one or more of the above features
o BP ≥140/90 mmHg before pregnancy or diagnosed Preeclampsia with severe features.
before 20 weeks gestation or,
o Hypertension first diagnosed after 20 weeks gestation Case: 20 y/o G2, 32 weeks AOG, came in for prenatal care
and persistent after 12 weeks postpartum BP=150/100mmHg, admitted for hypertensive work-up. 24 hr urine
albumin= 180 mg/24 hrs. SGPT 2x elevated Other labs normal. G1
Chronic HTN vs eclampsia vs Gestational HTN(>20 weeks) was complicated by eclampsia. What is the diagnosis?
Case: Dumating ung patient 25 years old, primigravida, 25 weeks a. Gestational htn
gestation. BP= 140/90 b. Preeclampsia
Answer:  Gestational Hypertension c. Chronic hypertension
d. Chronic hypertension with superimposed preeclampsia

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 Midterms (1st Sem) Hypertensive Disorders
Dr. Daisy Dulnuan
OBSTETRICS II· September 5, 2020

3. Uteroplacental perfusion
o Compromised uteroplacental perfusion from vasospasm is
almost certainly a major culprit in the genesis of increased
perinatal morbidity and mortality
4. Coagulation Changes
o Very minimal effect unless when DIC is present
o Increased Factor VIII consumption
o Increased level of fibrinopeptides A and B and D- dimers
o Decreased levels of regulatory proteins – Antithrombin III
and protein C and S
5. Volume Hemostasis
o Endocrine changes – increase levels of:
 Renin
 Angiotensin II
 Angiotensin 1-7
 Aldosterone
 Atrial natriuretic peptides
 Deoxycortisone – potent mineralocorticoid
A. RISK FACTORS 6. Fluid and Electrolyte Changes
 Nulliparous women o Reduced oncotic pressure  extravasation of fluid to the
 Race and ethnicity (African-American) extracellular compartment  edema
 Genetic predisposition 7. Liver
 Environmental factors o Periportal hypertension in the liver periphery  hepatic
 Chronic hypertension infarction followed by hemorrhage  necrosis
 Multifetal gestation o Elevated transaminases
 Maternal age over 35 years o Moderate to severe RUQ to midepigastric pain  severe
disease
 Obesity
Table 1: HELLP SYNDROME
B. ETIOLOGY H HEMOLYSIS  LDH> 600 U/L
 Exposed to chorionic villi for the first time  Total Bilirubin >1.2
 Exposed to a superabundance of chorionic villi as with twins or mg/dL
hydatidiform mole  Abnormal PBS
 Have a preexisting vascular disease EL ELEVATED LIVER SGPT >70 U/L
 Genetically predisposed to hypertension developing during ENZYMES
pregnancy LP LOW PLATELETS <100,000

C. POTENTIAL CAUSES 8. Kidney

 Abnormal trophoblastic invasion of uterine vessels o Reversible anatomical and pathophysiological changes:
 Maternal maladaptation to cardiovascular or inflammatory  Renal perfusion and GFR  reduced  oliguria
changes of normal pregnancy  Glomerular capillary endotheliosis
 Immunological intolerance between maternal and fetoplacental  Most common anatomical change seen in
tissues autopsy of patients with preeclampsia and
 Dietary deficiencies eclampsia
 Genetic influences  Proteinuria
 Acute tubular necrosis
D. PATHOGENESIS  Does not occur due to preeclampsia directly
 Vasospasm  eg. Preeclampsia can cause abruptio placenta
 Endothelial damage which can lead to ATN)
9. Brain
E. PATHOPHYSIOLOGY o Cortical and subcortical petechial hemorrhage
1. Cardiocascular System Changes o Classic microscopic vascular lesions
a) Increased cardiac afterload  Fibrinoid necrosis of the arterial wall
b) Left ventricular hypertrophy  Perivascular microinfarcts and hemorrhages
o Decrease cardiac output 10. Neurologic Manifestations
o Ventricular remodeling with diastolic dysfunction o Headache and scotoma
o Blood volume o Seizures
o Hemoconcentration -> hallmark of eclampsia o Blindness (reversible)
2. Hemodynamic Changes o Generalized cerebral edema
a) Blood volume 11. Visual Changes
 Hemoconcentration (Hallmark of eclampsia) o Scotoma, blurred vision or diplopia
b) Blood and Coagulation o Occipital blindness  amaurosis (Gk. dimming) reversible
 Thrombocytopenia results from platelt activation, o Retinal lesions
aggregation and consumption o Serous retinal detachment  unilateral
 The lower the PC, the higher the maternal and o Purtscher retinopathy  infarction
fetal morbidity and mortality
 HELLP Syndrome - an indication for delivery
 H - Hemolysis(LDH)
 EL - Elevated enzymes (AST or ALT)
 LP - Low Platelet count

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 Midterms (1st Sem) Hypertensive Disorders
Dr. Daisy Dulnuan
OBSTETRICS II· September 5, 2020

F. MANAGEMENT ***When is antihypertensive therapy indicated?

o Basic management objective for any pregnancy complicated  Antihypertensive treatment should be started in women with
preeclampsia are:  BP ≥160/110 mmHg
1. Termination of pregnancy with the least possible trauma  Other markers of potentially severe diseases
to mother and fetus  Treatment can be considered at lower degrees of BP
 Can be Vaginal Delivery, Not necessarily CS.
2. Birth of an infant who subsequently thrives/ lives ***Are any of the following present?
3. Complete restoration of health of the mother  Eclampsia
 Pulmonary edema
G. PREVENTION  Uncontrolled severe hypertension
o Dietary manipulation  Disseminated intravascular coagulation
o Calcium supplementation  Abruptio placenta
o Fish oil supplementation  Nonreassuring fetal status
o Antioxidant (Vit. C and E)
 IUFD
o Low dose aspirin
If YES  MAGNESIUM SULFATE AND DELIVERY
o Delivery is the only cure for preeclampsia
Case: A 28y/o G1, 28 weeks, was brought to the ER because of
H. MAIN OBJECTIVES IN THE MANAGEMENT OF SEVERE
loss of consciousness accompanied by tonic-clonic convulsion.
PREECLAMPSIA
BP=180/120 mm Hg. Which of the following management options
 Safety of the Mother is NOT correct?
o Forestall convulsion A. Give magnesium sulfate
o Prevent Intracranial hemorrhage B. Start antihypertensives
o Avoid Serious damage to vital organs C. Delivery after maternal stabilization
 Deliver a healthy infant who is able to thrive D. Steroids and expectant management
o The more term, chance of mortality is lower
o Objective: deliver baby as term as possible NO - HELLP or Partial HELLP
 ≥33 5/7 weeks
When is the woman with severe preeclampsia delivered?
 IUGR (<5th percentile)
 Magnesium sulfate for seizure
 Severe oligohydramnios
 Antihypertensive medications if indicated depending on level
 REDF in doppler of the umbilical artery
of hypertension
 Labor or PPROM
 Induction of labor or CS if with obstetrical indication:
 Significant renal dysfunction
 Pregnancies ≥34 weeks of gestation - if complicated by
 Persistent symptoms
severe preeclampsia, managed by delivery after
maternal stabilization *refer to a tertiary center w/
DELIVER if:
NICU
 With the above stated indications
Severe Preeclampsia remote from term  Doppler velocimetry has reverse diastolic flow (no blood flow
going to the baby)
 34 weeks - delivery is always appropriate because def mgt is
MAGNESIUM SULFATE if w/o the above criteria
to deliver the baby
Give steroids if <34 weeks and then deliver
 Not optimal fro premature fetus ≤34 weeks
ANTENATAL CORTICOSTEROIDS
I. COMPLICATIONS OF PREMATURITY
 BETAMETHASONE 12mg IM q24hrs x 2 doses
 Respiratory Distress Syndrome
o Last organ developed is fetal lung maturity  DEXAMETHASONE  6mg IM q12 hrs x 4 doses
Reduces:
 Intraventricular Hemorrhage
RDS, IVH, NEC, Perinatal death, long-term neurological problem
 Necrotizing Enterocolitis
 Sepsis
***Preeclampsia 160/110 with all the signs and symptoms but <24
 Death weeks
 Manage as nonpregnant kesa magstroke si mother
J. AN ALGORITHM IN THE EXPECTANT MANAGEMENT OF
SEVERE PREECLAMPSIA REMOTE FROM TERM (<34 WEEKS)
***Preeclampsia 24-33 6/7 weeks
 Observe in labor and delivery suite for 24-48 hours
 MgSO4 for 24 hrs
 Magnesium sulfate for 24 hrs
 Antihypertensives if needed
 Antihypertensives if indicated (Appendix B)
 Steroids
 Ultrasonography
 Daily evaluation of maternal-fetal condition
 Monitoring of FHT
 Delivery if with indications
 Symptoms and
 Delivery at 34 0/7 weeks
 Laboratory tests
***What blood pressure is aim of antihypertensive therapy?
***Magnesium sulfate in severe preeclampsia
 The aim of antihypertensive therapy is to keep the systolic
 Loading dose: 4-6 grams slow IV BP between between 140-155 mmHg and diastolic BP
 Maintenance Dose: 1-2 grams/hour between 90-100 mmHg
 Can be administered regardless of the renal function
*but dose must be adjusted
 Given during labor and continued up to 24 hours
postpartum
 Dose reduced to half if creatinine ≥1.1 mg/dL

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Reminders:
 Diuretics are now considered 2nd line agents and can be
used specially in women with salt-sansitive hypertension
particularly in the setting of reduced renal function.
 Diuretics are relatively contraindicated an reserved only for
pulmonary edema.
 Hyperosmotic agents (albumin) have the potential to
promote edema formation in the lungs and brain.
K. MATERNAL EVALUATION
 Weigh patient daily
 Monitor for s/sx
 BP monitoring q4 hrs except between 12MN and 6AM
 Laboratory: CBC with platelet count, Creatinine, SGPT,
Urinalysis, 24 hr urine albumin, LDH, PBS, Total Bilirubin
L. FETAL EVALUATION
 Baseline CTG
 Women in labor should have continuous EFM
 Biometry q2 weeks, BPS 2x/week, Doppler weekly and daily
NST
M. WHAT IS THE MODE OF DELIVERY?
 Determined after considering the presentation of the fetus and
the fetal condition, together with the likelihood of success of
induction of labor after assessment of the cervix
N. HOW IS POSTPARTUM HYPERTENSION MANAGED?
 REDUCE the antihypertensives if BP < 140/90 mmHg
 Antihypertensives indicated for BP ≥150/100 mmHg
 STOP the antihypertensive agesnts if BP < 130/80 mmHg
 Antihypertensive agents: Methyldopa, Diuretics
 Avoid NSAIDs
O. SEVERE PREECLAMPSIA <24 WEEKS
 High maternal morbidity
 High perinatal morbidity and mortality
 Pregnancy termination is recommended
P. HOW DOES SEVERE PREECLAMPSIA DIFFER FROM
PREECLAMPSIA WITHOUT SEVERE FEATURES AND
GESTATIONAL HYPERTENSION?
Table 2: GH, Preeclampsia w/o severe features vs Severe
Preeclampsia vs Chronic Hypertension
GH and Severe Chronic
Preeclampsia Preeclampsia hypertension
without severe
features
MgSO4 X  X b. Smoking
AOG at 37 wks 34 wks 38 wks
delivery
Anti-HPN 160/110 mm 160/110 mm 160/110 mm
Hg Hg Hg
QUESTIONS TO ANSWER:
1. Which of the following is not correct?
a. A pregnant with gestational hypertension has no proteinuria
b. G1, 32 weeks BP 140/90; 24hr CHON 30 mg; platelet: 90 - severe
preeclampsia
c. G2, 32 weeks, HELLP syndrome - give steroids then deliver
d. G3, CH with SPE mild, 30 weeks - give MgSO4 for 24 hrs
2. Case: 20 y/o G1 at 30 weeks with a BP of 150/90 mm Hg was
brought to the OPD because of bilateral pedal edema. Urinalysis
done outside revealed a +4 protein and platelet count at 95,000.
What is the best management for this case?
a. Admit, give MgSO4, steroids, monitor BP
b. Admit MgSO4, steroids then deliver
c. Admit, stabilize and deliver by CS
d. Admit for induction of labor then give MgSo4 postpartum
MAPALO | PAGUIRIGAN | QUINTO | TAMANI
Midterms (1st Sem) Hypertensive Disorders
Dr. Daisy Dulnuan
OBSTETRICS II· September 5, 2020
Additional Reading Materials
William’s Obstetrics 25th Edition
References
 Cunningham, G. et al. (2014). Williams Obstetrics.25th Edition. USA: McGraw-
Hill Professional Publishing.
 Hoffman, B. et al. (2014). Williams Obstetrics Study Guide 24th Edition. USA:
McGraw-Hill Professional Publishing.
 Dr. Dulnuan’s lecture/powerpoint presentation
Williams 24th edition Study Guide
1. What proportion of maternal deaths can be attributed to
hypertensive disorders in pregnancy?
a. 1 in 2 b. 1 in 6 c. 1 in 10
2. A patient has a blood pressure of 110/72 mm Hg on her first
prenatal visit at 8 weeks’ gestation. She develops hypertension in
the third trimester, and at delivery, her blood pressure is 148/94
mm Hg. Urine protein by dipstick is trace, her creatinine level is
0.76 mg/dL, and her hypertension has resolved by the time of her
hospital discharge. What is her correct diagnosis?
a. Preeclampsia b. Chronic hypertension c. Gestational hypertension
3. A patient with antepartum baseline blood pressure
measurements of 90/65 mm Hg has blood pressures of 130–
140/80–86 mm Hg at delivery. She has an increased risk of which
of the following obstetric complications?
a. Eclampsia c. Nonreassuring FHR tracing
b. Placental abruption d. NOTA
4. A multiparous patient who received no prenatal care presents
to Labor and Delivery with a complaint of vaginal bleeding. Her
fundal height is 24 cm. Which of the following laboratory test
supports the dx of preeclampsia?
a. Creatinine 1.14 mg/dL
b. Platelet count 103,000/μL
c. Alkaline phosphatase 138 IU/L
5. For the patient in Question 4, a sonographic examination is
performed to estimate gestational age. Which of the following
may explain the development of preeclampsia in this patient?
a. Increased volume of chorionic villi
b. Extensive remodeling of the spiral arterioles
c. Increased invasion of extravillous trophoblasts
6. What is the underlying etiology for proteinuria that is seen with
preeclampsia?
a. Increased capillary permeability
b. Increased renal artery resistance
c. Increased glomerular filtration rate
7. All EXCEPT which of the following increase a woman’s
predisposition to develop preeclampsia syndrome?
a. Obesity c. Nulliparity
d. Multiple gestation
8. Which of the following nutritional supplements has been shown
to reduce the incidence of preeclampsia?
a. Calcium c. Ascorbic acid
b. Vitamin E d. NOTA
9. Which of the following physiological responses is typically
seen in preeclamptic patients?
a. Increased production of nitric acid
b. Decreased reactivity to norepinephrine
c. Increased sensitivity to angiotensin II
10. The typical blood volume of a gravida at term is 4500 mL. In
patients with preeclampsia, which of the following would be the
expected blood volume?
a. 2500 mL
b. 3200 mL
11. In patients with preeclampsia, limited blood volume expansion
during pregnancy affects maternal cardiac function by which
mechanism?
a. Decreases preload
b. Increased afterload
c. Increases stroke volume
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12. A neonate is born vaginally after 6 hours of labor and a few
minutes of pushing. He has petechiae covering his scalp and
chest, and his pediatric nurse notices oozing at the site of a heel
stick. His initial platelet count is 32,000/μL. Which of the following
maternal hypertensive conditions predisposes to this neonatal
condition?
a. Eclampsia c. Gestational hypertension
b. Preeclampsia d. NOTA
13. A primigravida delivered 4 hours ago. Her blood pressure was
152/90 mmHg before delivery, and 1+ proteinuria was found by
dipstick. Her delivery was uneventful and her estimated blood
loss was 500 mL. You get a call from the nurse because her urine
output for the past 4 hours is only 118 mL. Her BP IS 148/88, pulse
is 84, she has 12 respiratory per minute, and no evidence of
ongoing bleeding is noted. Which of the following treatment
options is most appropriate for this patient?
a. Continue observation
b. Give 10 mg intravenous furosemide
c. Give 500 mL bolus of IV normal saline
14. Which of the following leads to increased uric acid levels in
patients with preeclampsia?
a. Increased tubular reabsorption
b. Increased placental production
c. Decreased GFR
d. AOTA
15. Your obstetrical patient presents with a blood pressure of
160/140 mmHg, 3+ proteinuria, and RUQ discomfort at 36 weeks’
gestation. Following induction of labors, she delivers vaginally.
She has urine atony, and her estimated blood loss is 1500 mL. Her
serum creatinine rises from 0.98 mg/dL predelivery to 1.42 mg/dL.
What is the most likely explanation for this finding?
a. Postpartum hemorrhage
b. Severe preeclampsia alone
16. Cerebral edema was diagnosed on a postpartum hypertensive
patient with confusion. For what associated morbidity is the
patient at risk?
a. Cystic leukomalacia c. Transtentorial herniation
b. Retinal artery occlusion
17. All EXCEPT which of the following are indicated treatments in
the management of the patient discussed in Question 19?
a. Mannitol c. Intravenous immune globulin
b. Dexamethasone d. Antihypertensive medication
18. In a low-risk population, treatment with which of the following
medications resulted in a reduced incidence of preeclampsia?
a. Aspirin b. Pravastatin c. Hydrochlorothiazide d. NOTA
19. Your obstetrical patient is admitted to the hospital for
evaluation of new-onset HTN at 30 weeks gestation. All EXCEPT
which of the following should be part of your evaluation?
a. Maternal weight c. Fetal sonographic evaluation
b. Cell-free fetal DNA testing d. Maternal urine protein:creatinine ratio
20. The patient in Question 22 has blood pressures of 140-5/85-
100 mmHg during the next 5 days. Which of the following should
prompt consideration for premature delivery?
a. Headache
b. 3+ proteinuria on dipstick
c. Fetal biophysical profile score of 8
21. Three days after admission, the patient in Question 23
develops severe preeclampsia and delivery is indicated.
Sonographic evaluation reveals a cephalic presentation and
estimated fetal weight of 1405 g. if labor induction is attempted,
what is the approximate rate of successful vaginal delivery?
a. 10% b. 30% c. 50%
22. In studies evaluating the antenatal use of labetalol for
treatment of early mild preeclampsia, which of the following is
reduced?
a. Blood pressure
b. Fetal growth restriction
c. Length of inpatient hospitalization
MAPALO | PAGUIRIGAN | QUINTO | TAMANI
Midterms (1st Sem) Hypertensive Disorders
Dr. Daisy Dulnuan
OBSTETRICS II· September 5, 2020
23. What is the concern surrounding use of corticosteroids to
enhance fetal lung maturation in women with severe hypertension
prior to 34 weeks’ gestation?
a. Time needed for corticosteroids administration may delay delivery
b. It may trigger eclampsia in women with a genetic predisposition to
seizures.
24. What salutary effect does dexamethasone possible have when
used in the treatment of HELLP (hemolysis, elevated liver
enzymes, low platelet count) syndrome?
a. Decreased maternal mortality rate
b. Decreased rate of acute renal failure
c. Faster aspartate transferase recovery time
d. Increased platelet count in severe thrombocytopenia
25. An eclamptic patient who received a 4-g loading dose of
magnesium sulfate has another seizure. Which of the following
medications can be given as adjuvant anticonvulsant therapy?
a. Midazolam c. Additional magnesium sulfate
b. Thiopental d. AOTA
26. What is the target magnesium level when used for eclampsia
prophylaxis?
a. 2.0-3.5 mg/dL b. 4.8-8.4 mg/dL c. 8.4-10.4 mg/dL
27. What clinical sign or test can be used to detect
hypermagnesia prior to development of respiratory depression?
a. Heart rate b. Patellar reflex c. Presence of clonus
28. Which of the following strategies for administering
magnesium sulfate for eclampsia prophylaxis should be used in
the setting of an elevated serum creatinine?
a. Give no loading dose and start infusion at 2 g/hr
b. Give 3-g loading dose followed by 2 g/hr infusion
c. Give 3-g loading dose, check magnesium level and then titrate
infusion rate
d. NOTA
29. A pregnant patient has a seizure at home and is evaluated by
and emergency room physician. He consults with a neurologist
who, after excluding other etiologies for the seizure, makes the
diagnosis of eclampsia. The neurologist recommends phenytoin
for eclampsia prophylaxis to the on-call obstetrician. What is the
best response to this recommendation?
a. Agree and load the patient with phenytoin
b. Give IV loading does of magnesium sulfate and oral phenytoin
c. Explain there is a reduction of recurrent seizure activity with
magnesium sulfate and start magnesium sulfate
30. Antenatal use of nitroglycerin to control severe maternal
hypertension can lead to which of the following complications?
a. Fetal acidosis
b. Fetal oliguria
c. Fetal cyanide toxicity
31. Use of hydroxyethyl starch to expand intravascular volume
improve which of the following pregnancy outcomes in women
with preeclampsia?
a. Eclampsia
b. Fetal death rate
c. Gestational age at delivery
d. NOTA
32. Preeclampsia is a marker for all EXCEPT which of the
following morbidities later in life?
a. Metabolic syndrome
b. Chronic renal disease
c. Ischemic heart disease
d. Nonalcoholic steatohepatitis
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 Midterms (1st Sem) Hypertensive Disorders
Dr. Daisy Dulnuan
OBSTETRICS II· September 5, 2020

Appendix A
PREDICTORS OF PREGNANCY-INDUCED HYPERTENSION

Appendix B
ANTI-HYPERTENSIVE MEDICATIONS DURING PREGNANCY

DRUG DOSE/ROUTE COMMENTS

LABETALOL 10-20 mg IV then 20-80 mg every 30 mins; max Not readily available locally
of 300 mg
HYDRALAZINE 5 mg IV or IM then 5 mg every 30 mins; max of Long experience of safety and efficacy
20mg
NIFEDIPINE 10-20 mg PO then 10-200 mg every 2-6 hrs; Drug of choice used
max of 50 mg Can be safely used with Mg SO4
IV NICARDIPINE D5W 90 ml + Nicardipine 10 mg in soluset Can be safely used with Mg SO4
Concentration = 0.1mg/mL
Start drip at 10 ugtts/min (equiv.to 1mg/hr)
Titrate every hour (increments of 1 mg/hr)
Max.dose 10 mg/hr
Note: the IV infusion site must be changes every
12 hrs
METHYLDOPA (B) Max of 3 grams per day Drug of choice
NIFEDIPINE © 30-120 mg/day PO Slow or long-acting preparations may be used
SL preparation should be avoided
LABETALOL 200-2400 mg/dayin 2-3 divided doses Not readily available locally

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