9. HYPERTENSIVE DISORDERS OF PREGNANCY— Sibai, 2002 Severe Disease Absent Absent Hepatic Dysfunction Severe Disease Absent Absent Thrombocytopenia Severe Disease Absent Absent Hemoconcentration Usually present Absent Absent Proteinuria Mild or severe Mild Mild or severe Degree of Hypertension ≥ 20 weeks Usually in 3rd Trimester < 20 weeks Time of Onset of Hypertension PREECLAMPSIA GESTATIONAL HYPERTENSION CHRONIC HYPERTENSION CLINICAL FINDINGS
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21. Blood Component Therapy Platelet count 50,000 or > 50 mL Platelets 1 unit ↑ count 50,000 Platelet concentration Replace clotting factors Fibrinogen > 100mg/dL 15-20 mL Clotting factors 1 unit ↑ Fibrinogen 10 mg/dL Cryoprecipitate Replace clotting factors Fibrinogen > 100mg/dL 180-200 mL Clotting factors 1 unit ↑ Fibrinogen 10 mg/dL FFP Hct 30% 200-275 mL RBC 1 unit ↑ Hct 3 % Packed RBC’s Goal Volume Content Component
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Hinweis der Redaktion
Terminology is inconsistent
Edema not as significant below waist now.
These categories develop during pregnancy. Multisystem syndrome.
These two are related to preexisting conditions. Primary pathology is elevated B/P
How often do office wait 6 hours before sending pt in to triage? Make sure accurate size b/p cuff is used
Many theories as to the cause
Placental role explains why delivery is the cure and why multiple gestation more prone to preeclampsia ie greater placental tissue.
New screening test: protein/creatine ratio. Done with urine. If results are <.16 then there will be <300 mg protein in 24 hr urine
many institutions have massive bld transfusion protocol so all these components are given vs just PRBCs
Mack truck, with bolus, anti-emetic to prevent emesis
Can not give with myasthenia gravis. Excreted by kidneys so be aware of renal function Magnesium continues until 24 hours after delivery
B/P can be labile. Need to use consistent size cuff. Pt should be on side when b/p taken
Preeclamptic nose – periorbital edema – spreads out nose
Are there other kids at home? Does she have help in the house? Pt education about reasons to call the doctor.
No visitation from kids, financial difficulties, child care issues, loss of control
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