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pre-eclampsia
BP > 140/90 with proteinuria after 20weeks gestation
severe-preeclampsia includes higher BP (DBP > 100-115) and systemic symptoms
renal dysfunction
pulmonary edema
blurred vision
AMS
hepatic dysfunction
low platelets
No diuretics or nitroprusside (lower placental blood flow) or ACEi
Mg has a mortality benefit and prevents seizures
titrate to DBP < 90
HELLP syndrome is a severe pre-eclampsia though 20% patients are without HTN
can lead to ruptured subcapsular liver hematoma and hemorrhagic shock
dexamethasone tried without benefit
urgent delivery and Mg
Acute fatty liver of pregnancy
no hemolysis
ALF
delivery/termination of pregnancy
TTP of pregnancy
sometimes overlaps with HELLP
sometimes normal liver enzymes
more mental status changes
DIC NOT present
does not resolve with delivery
plasmapheresis
eclampsia includes seizures
Peripartum cardiomyopathy incidence is in final month of pregnancy to 5mo postpartum
LVEF < 45% is definition, treatment is similar to systolic dysfxn
patients should not get pregnant again
high risk for intramural thrombus ?anticoagulation
Hemorrhage
painless - previa
painful and no overt bleeding - abruption
- associated with DIC
a pregnant woman can lose 2L of blood and still have normal vital signs and the fetus will show abnl vital signs first
Oxygenation
Umbilical vein PaO2 is high 30s but results in fetal SaO2 of 80-90%
Acidemia does not improve uterine artery blood flow because it is maximally dilated but may improve fetal oxygen transfer by right shifting maternal Hb curve
Fetal Hb is much less sensitive to maternal pH
however, permissive hypercapnia effects on fetus is unknown and recommendations are to keep pH normal (slightly alkalemic)
Maternal alkalemia reduces uterine blood flow as does catecholamines. Alkalemia also reduces oxygen delivery to fetus.
Maternal fetal circulation is via concurrent exchange, which is less efficient.
Fetal oxygenation most dependent on cardiac output, uterine blood flow, and Hg
Respiratory mechanics
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