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Hypertensive Disorders

Preeclampsia

• Diagnosis: BP ≥140/90 after 20 weeks + proteinuria
• Classic triad: hypertension, edema, proteinuria
• Risk factors: nulliparity, multifetal gestation, diabetes, chronic hypertension, obesity
• Mild: BP 140/90-159/109, 1+ protein, mild edema
• Severe: BP ≥160/110, 3-4+ protein, severe edema, hyperreflexia, visual disturbances, epigastric pain
• Late sign: epigastric pain (liver edema) - requires immediate intervention
• Treatment: magnesium sulfate (prevents seizures), antihypertensives, delivery
• Magnesium toxicity: monitor respirations (<12/min), DTRs, urine output; antidote: calcium gluconate

HELLP Syndrome

• Hemolysis
• Elevated Liver enzymes
• Low Platelets
• Complication of severe preeclampsia

Bleeding Disorders

Placenta Previa

• Placenta implanted over cervical os
• Painless, bright red bleeding (usually third trimester)
• NO vaginal exams (can cause hemorrhage)
• Treatment: bed rest, tocolytics, steroids for fetal lung maturity, cesarean delivery

Abruptio Placentae

• Premature separation of normally implanted placenta
• Painful, dark red bleeding, board-like abdomen
• Associated with hypertension, trauma, cocaine use, smoking
• Emergency: immediate delivery (usually cesarean)

Ectopic Pregnancy

• Implantation outside uterine cavity (usually fallopian tube)
• Sharp lower abdominal pain, spotting, amenorrhea
• Rupture: severe pain, hypovolemic shock
• Treatment: surgery (salpingectomy) or methotrexate

Gestational Diabetes

• Glucose intolerance first recognized during pregnancy
• Screening: 1-hour glucose challenge test (24-28 weeks)
• Diagnosis: 3-hour oral glucose tolerance test
• Management: diet, exercise, blood glucose monitoring, insulin if needed
• Risks to fetus: macrosomia, hypoglycemia, respiratory distress, polycythemia

Hyperemesis Gravidarum

• Severe nausea/vomiting causing dehydration, electrolyte imbalance, weight loss
• Treatment: IV fluids, antiemetics, nutritional support, hospitalization