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Hypertensive Disorders of Pregnancy
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Hypertensive Disorders of Pregnancy
Hypertensive Disorders of Pregnancy
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1
Question
What does the graph in FIGURA 40-1 depict?
Answer
Changes in arterial pressure during pregnancy, with 'Semanas de gestación' (weeks of gestation) on the x-axis and 'Presión arterial' (arterial pressure) on the y-axis.
2
Question
What do the blue and red lines in FIGURA 40-1 represent?
Answer
The blue line represents the blood pressure trend of 'Paciente A' (Patient A), and the red line represents the blood pressure trend of 'Paciente B' (Patient B).
3
Question
According to the document, what reflects multiple organ injury?
Answer
Thrombocytopenia, renal insufficiency, hepatocellular necrosis, central nervous system alterations, or pulmonary edema.
4
Question
What are the required criteria for gestational hypertension according to CUADRO 40-1?
Answer
BP > 140/90 mmHg after the 20th week in previously normotensive women.
5
Question
What platelet count indicates thrombocytopenia, according to CUADRO 40-1?
Answer
Platelets < 100,000/µL.
6
Question
What serum creatinine level indicates renal insufficiency, according to CUADRO 40-1?
Answer
Creatinine > 1.1 mg/100 mL or double the baseline (without previous nephropathy).
7
Question
According to CUADRO 40-2, what diastolic blood pressure reading is considered 'grave'?
Answer
≥ 110 mmHg
8
Question
List some symptoms considered worrisome that may precede eclampsia.
Answer
Headache or visual disturbances.
9
Question
What does epigastric or right upper quadrant pain often accompany?
Answer
Hepatocellular necrosis, ischemia, and hepatic edema.
10
Question
What are the criteria for diagnosing superimposed preeclampsia in women with chronic hypertension?
Answer
New onset or worsening hypertension accompanied by new onset proteinuria or other findings listed in cuadro 40-1 after 24 weeks of gestation.
11
Question
Which factors contribute to a higher risk of preeclampsia, according to Bartsch et al. (2016)?
Answer
Older age, nulliparity, obesity, diabetes, and chronic hypertension.
12
Question
According to CUADRO 40-3, what is the combined unadjusted relative risk for preeclampsia in nulliparous women?
Answer
2.1 (1.9-2.4)
13
Question
According to CUADRO 40-3, what is the combined unadjusted relative risk for preeclampsia in women with chronic hypertension (CHTN)?
Answer
5.1 (4.0-6.5)
14
Question
According to FIGURA 40-2, approximately what was the frequency of eclampsia per 10,000 births in Parkland Hospital in 2018?
Answer
Approximately 4.8
15
Question
List the characteristics that make gestational hypertensive disorders more probable.
Answer
First-time exposure to chorionic villi, exposure to an overabundance of chorionic villi, pre-existing disorders with endothelial cell activation or inflammation, genetic predisposition to hypertension during pregnancy.
16
Question
Describe phase I of the 'two-phase disorder' theory in the pathogenesis of preeclampsia, according to Redman et al. (2015).
Answer
Phase I, the placental syndrome, is caused by defective endovascular trophoblastic remodeling, which later leads to phase II, the maternal syndrome.
17
Question
What is the role of extravillous trophoblasts in normal placental implantation, as described in the chapter?
Answer
They replace the vascular endothelium and muscle layers within the spiral arterioles, leading to an increased diameter of the arterioles.
18
Question
According to the text, what is one theory cited for preeclampsia related to the immune system?
Answer
Loss of maternal immune tolerance to placental antigens derived from the father and fetus.
19
Question
What does a lower amount of the immunosuppressive non-classical human leukocyte antigen G (HLA-G) expressed by extravillous trophoblasts early in pregnancy indicate?
Answer
It indicates that women are destined to develop preeclampsia.
20
Question
Is preeclampsia considered a multifactorial and polygenic disorder?
Answer
Yes, it is considered a multifactorial and polygenic disorder.
21
Question
What are some of the inflammatory mediators that contribute to generalized oxidative stress in preeclampsia?
Answer
Cytokines such as tumor necrosis factor α (TNF-α) and interleukins.
22
Question
What is the effect of damaged or activated endothelial cells on nitric oxide production?
Answer
Damaged or activated endothelial cells produce less nitric oxide.
23
Question
How are pregnant women typically resistant to vasopressors injected, as described in Chapter 4?
Answer
The resistance is partially due to a lower vascular response controlled by the endothelial synthesis of prostaglandins.
24
Question
What happens to endothelin 1 (ET-1) concentration in pregnant women with preeclampsia?
Answer
It increases even more than in normotensive pregnant women and these peptides sometimes intervene in kidney damage.
25
Question
What does 'angiogenic imbalance' refer to in the context of preeclampsia?
Answer
It describes an excessive amount of anti-angiogenic factors.
26
Question
How does elevated maternal levels of sFlt-1 (soluble fms-like tyrosine kinase 1) affect endothelial function?
Answer
It causes endothelial dysfunction by reducing circulating levels of PIGF and VEGF.
27
Question
What does the left side of FIGURA 40-4 show?
Answer
It depicts the inside and outside of a red blood vessel that shows normal conditions.
28
Question
What does the right side of FIGURA 40-4 show?
Answer
It depicts the inside and outside of a red blood vessel that shows preeclamptic conditions.
29
Question
¿Cuáles son las tres principales causas de las alteraciones del sistema cardiovascular en la preeclampsia?
Answer
Mayor poscarga cardiaca por hipertensión, menor precarga por menor expansión del volumen, y activación endotelial con filtración de líquido intravascular.
30
Question
¿Qué factores modifican las aberraciones cardiovasculares en los trastornos hipertensivos del embarazo?
Answer
La gravedad de la preeclampsia, el grado de hipertensión, la presencia de alguna enfermedad crónica de fondo y el punto del espectro clínico en el que estos se estudian.