Trastornos Hipertensivos del Embarazo

Descripción General

Clasificación y definiciones

• La hipertensión es la elevación de la PA:
  • PA sistólica ≥ 140 mm Hg; y/o
  • PA diastólica ≥ 90 mm Hg
• Hipertensión crónica es la hipertensión diagnosticada a < 20 semanas de edad gestacional (EG).
• Hipertensión gestacional es la hipertensión diagnosticada a ≥ 20 semanas de edad gestacional cuando la PA era previamente normal.
• Preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders/ eclampsia Eclampsia Onset of hyperreflexia; seizures; or coma in a previously diagnosed pre-eclamptic patient (pre-eclampsia). Hypertensive Pregnancy Disorders/HELLP es un espectro de hipertensión gestacional con proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children y/o daño de órganos diana:
  • Preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders sin características de severidad:
    • Anteriormente denominada “preeclampsia leve”.
    • Hipertensión gestacional con proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children
    • No hay signos o síntomas que sugieran daños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria órganos finales
  • Preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders con características de severidad:
    • Anteriormente denominada “preeclampsia grave”
    • Hipertensión gestacional con síntomas adicionales o hallazgos de laboratorio que sugieren daños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria órganos finales
  • Eclampsia Eclampsia Onset of hyperreflexia; seizures; or coma in a previously diagnosed pre-eclamptic patient (pre-eclampsia). Hypertensive Pregnancy Disorders: preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders con convulsiones
  • Síndrome HELLP: preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders con hemólisis, plaquetas bajas y/o disfunción hepática

Epidemiología

• Los LOS Neisseria trastornos hipertensivos complican el 5%-10% de los LOS Neisseria embarazos.
• Hipertensión crónica:
  • Se produce en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 1% de los LOS Neisseria embarazos.
  • El 20%-25% de las mujeres con hipertensión crónica desarrollan preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders durante el embarazo.
• Hipertensión gestacional: se produce en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 5%-6% de los LOS Neisseria embarazos
• Preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders/ eclampsia Eclampsia Onset of hyperreflexia; seizures; or coma in a previously diagnosed pre-eclamptic patient (pre-eclampsia). Hypertensive Pregnancy Disorders/HELLP:
  • Ocurre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 2%-8% de todos los LOS Neisseria embarazos
  • La incidencia es 1,5-2 veces mayor en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria primeros embarazos.
• El 70% de las mujeres que tienen una crisis eclámptica sufrirán complicaciones maternas, con una morbilidad que alcanza el 14%.

Factores de riesgo

Factores de alto riesgo:

• Antecedentes de preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders
• Situaciones que reducen el flujo sanguíneo uteroplacentario y/o provocan enfermedades vasculares:
  • Antecedentes de hipertensión crónica
  • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
  • Enfermedad renal
  • Enfermedad autoinmune
  • Gestación múltiple

Factores de riesgo moderados:

• Nuliparidad
• 10 años entre embarazos
• IMC > 30
• Nivel socioeconómico bajo
• Raza afroamericana
• Antecedentes familiares de preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un familiar de primer grado
• Edad materna avanzada (≥ 35 años en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el momento del parto)
• Antecedentes de restricción del crecimiento fetal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un embarazo previo

Fisiopatología

Hipertensión en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el embarazo

La fisiopatología completa de los LOS Neisseria trastornos hipertensivos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el embarazo no se comprende del todo, pero la mayoría de las teorías implican un problema de invasión citotrofoblástica de las arterias espirales maternas.

Preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders y síndrome HELLP

• Patogénesis sospechada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders:
  • Remodelación defectuosa de la arteria espiral en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la decidua/miometrio →
  • Hipoperfusión placentaria →
  • Liberación de numerosos factores de la placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity hacia la circulación materna →
  • Vasoconstricción sistémica y disfunción endotelial →
  • Hipertensión →
  • Proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children y/o daño de órganos diana
• El síndrome HELLP es una extensión de la preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders
  • Puede estar estrechamente relacionado con el síndrome hemolítico urémico atípico
  • Fisiopatología sospechada del síndrome de HELLP:
    • Lesión endotelial con depósitos de fibrina →
    • Microangiopatía trombótica →
    • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica microangiopática + inflamación hepática + activación y consumo de plaquetas →
    • Trombocitopenia + elevación de enzimas hepáticas

Eclampsia Eclampsia Onset of hyperreflexia; seizures; or coma in a previously diagnosed pre-eclamptic patient (pre-eclampsia). Hypertensive Pregnancy Disorders

• Escasamente entendida, pero comúnmente se piensa que es multifactorial
• Se cree que las convulsiones son causadas por vasoespasmo cerebral y edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema cerebral.
• La encefalopatía hipertensiva también puede desempeñar un papel importante.

Presentación Clínica y Diagnóstico

Todos los LOS Neisseria trastornos se diagnostican utilizando criterios clínicos definidos. Los LOS Neisseria criterios incluyen el momento de la presentación, la PA, la presencia o ausencia de proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children y la presencia de síntomas o hallazgos de laboratorio que sugieran daños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria órganos finales.

Hipertensión crónica

• Asintomática
• Criterios de PA:
  • PA sistólica ≥ 140 mm Hg y/o
  • PA diastólica ≥ 90 mm Hg
  • Medida en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 2 ocasiones separadas, con al AL Amyloidosis menos 4 horas de diferencia
• Comienza antes de la semana 20 de gestación
• A menudo existe antes del embarazo
• No hay proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children de novo o daño de órgano diana
• Los LOS Neisseria individuos pueden desarrollar una preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders superpuesta si hay un aumento significativo de la PA o evidencia de nuevos daños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria órganos finales.

Hipertensión gestacional

• Asintomática
• Presión arterial sistólica ≥ 140 mm Hg y/o presión arterial diastólica ≥ 90 mm Hg
• Comienza durante o después de la semana 20 de gestación
• Sin antecedentes de hipertensión preexistente
• No hay proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children o daños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum órganos diana

Preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders SIN criterios de severidad

Hipertensión gestacional con proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children:

• Asintomática
• Ocurre entre la semana 20 de edad gestacional y hasta 6 semanas postparto.
• Criterios de hipertensión ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 2 lecturas, al AL Amyloidosis menos 4 horas aparte):
  • Presión arterial sistólica ≥ 140 mm Hg, pero <160 mm Hg; y/o
  • Presión arterial diastólica ≥ 90 mm Hg, pero < 110 mm Hg
• Criterios de proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children:
  • Recolección de orina de 24 horas ≥ 300 mg de proteínas o
  • Relación proteína/creatinina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina al AL Amyloidosis azar ≥ 0,3
  • Lectura de tira reactiva de ≥ 2+ (utilizar sólo si no se dispone de otros métodos cuantitativos)

Preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders CON criterios de severidad

Hipertensión gestacional con lecturas de PA aún más elevadas y/o signos/síntomas de daño en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria órganos diana:

• Frecuentemente (pero no siempre) sintomática
• Ocurre entre las 20 semanas de gestación y hasta las 6 semanas postparto
• Criterio diagnóstico #1: PA en “rango severo” con proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children (mismos criterios de proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children que los LOS Neisseria anteriores):
  • PA sistólica ≥ 160 mm Hg; y/o
  • PA diastólica ≥ 110 mm Hg
  • No es necesario esperar 4 horas para confirmar el diagnóstico antes de iniciar la terapia
• Criterios diagnósticos #2: PA en “rango leve” (140‒159 mm Hg/90‒109 mm Hg) y al AL Amyloidosis menos 1 de los LOS Neisseria siguientes criterios (signos/síntomas de posible daño de órganos diana) con o sin proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children:
  • Criterios de laboratorio:
    • Trombocitopenia (plaquetas < 100.000) Deterioro de la función hepática ( AST AST Enzymes of the transferase class that catalyze the conversion of l-aspartate and 2-ketoglutarate to oxaloacetate and l-glutamate. Liver Function Tests/ ALT ALT An enzyme that catalyzes the conversion of l-alanine and 2-oxoglutarate to pyruvate and l-glutamate. Liver Function Tests > 2 veces el límite superior de la normalidad)
    • Insuficiencia renal (creatinina al AL Amyloidosis doble de la basal o > 1,1 mg/dL)
  • Síntomas cerebrales:
    • Cefalea intensa
    • Alteración del estado mental
  • Síntomas visuales
    • Escotomas
    • Fotofobia
    • Visión borrosa
    • Ceguera temporal
  • Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar: se presenta con disnea; se confirma con una radiografía de tórax
  • Dolor Dolor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadrante superior derecho y/o epigástrico
• Otros posibles hallazgos (no diagnósticos):
  • Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema periférico
  • Náuseas/vómitos
  • Oliguria Oliguria Decreased urine output that is below the normal range. Oliguria can be defined as urine output of less than or equal to 0. 5 or 1 ml/kg/hr depending on the age. Renal Potassium Regulation
  • Accidente cerebrovascular

Eclampsia Eclampsia Onset of hyperreflexia; seizures; or coma in a previously diagnosed pre-eclamptic patient (pre-eclampsia). Hypertensive Pregnancy Disorders

• Una manifestación convulsiva de los LOS Neisseria trastornos hipertensivos relacionados con el embarazo.
• Las convulsiones pueden ser:
  • Tónico- clónicas generalizadas
  • Focales
  • Multifocales
• Las convulsiones a menudo son precedidas por signos premonitorios (e.g., cefalea, cambios en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la visión)
• Más de ⅓ de los LOS Neisseria individuos no muestran los LOS Neisseria hallazgos clásicos de la preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders antes del 1er evento convulsivo
• Los LOS Neisseria mismos síntomas potenciales que la preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders con características graves

Síndrome HELLP

Una forma de preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders severa con:

• Hemolysis (hemólisis)
  • Síntomas:
    • Palidez
    • Malestar
  • Hallazgos de laboratorio:
    • ↑ LDH LDH Osteosarcoma (> 2x el límite superior de la normalidad)
    • ↑ Bilirrubina
    • Esquistocitos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el frotis de sangre periférica
    • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types
• Elevated Liver enzymes Enzymes Enzymes are complex protein biocatalysts that accelerate chemical reactions without being consumed by them. Due to the body’s constant metabolic needs, the absence of enzymes would make life unsustainable, as reactions would occur too slowly without these molecules. Basics of Enzymes (Enzimas hepáticas elevadas)
  • Síntomas:
    • Dolor Dolor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadrante superior derecho
    • Náuseas y vómitos
  • Hallazgos de laboratorio: ↑ AST AST Enzymes of the transferase class that catalyze the conversion of l-aspartate and 2-ketoglutarate to oxaloacetate and l-glutamate. Liver Function Tests y/o ALT ALT An enzyme that catalyzes the conversion of l-alanine and 2-oxoglutarate to pyruvate and l-glutamate. Liver Function Tests (> 2 x el límite superior de la normalidad)
  • Puede causar un hematoma Hematoma A collection of blood outside the blood vessels. Hematoma can be localized in an organ, space, or tissue. Intussusception hepático que se rompe → hemoperitoneo
• Low Platelets (Plaquetas bajas):
  • Síntomas: La hemorragia clínica es posible pero infrecuente.
  • Hallazgos de laboratorio: Trombocitopenia (< 100 000)

Para las guardias: evaluación clínica práctica

Buscar trastornos hipertensivos del embarazo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la clínica o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un entorno de emergencia:

• Evalúe la PA.
• Pregunte por los principales “síntomas de preeclampsia”:
  • Cefalea
  • Dificultad para respirar
  • Cambios visuales
  • Dolor Dolor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadrante superior derecho
• Pida análisis de preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders:
  • Relación proteína:creatinina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una muestra de orina al AL Amyloidosis azar
  • Hemograma
  • LDH LDH Osteosarcoma
  • Pruebas de función hepática: AST AST Enzymes of the transferase class that catalyze the conversion of l-aspartate and 2-ketoglutarate to oxaloacetate and l-glutamate. Liver Function Tests, ALT ALT An enzyme that catalyzes the conversion of l-alanine and 2-oxoglutarate to pyruvate and l-glutamate. Liver Function Tests
  • Pruebas de la función renal: creatinina
• Confirmar el bienestar fetal, normalmente con una prueba de no estrés.
• Iniciar una recolecta de orina de 24 horas si el diagnóstico no está claro.

Tratamiento

El tratamiento definitivo de la hipertensión gestacional, la preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders, la eclampsia Eclampsia Onset of hyperreflexia; seizures; or coma in a previously diagnosed pre-eclamptic patient (pre-eclampsia). Hypertensive Pregnancy Disorders y el HELLP es el parto.

Prevención

• Se utiliza cuando hay 1 factor de alto riesgo o ≥ 2 factores de riesgo moderado
• Profilaxis con 81 mg de aspirina iniciando entre las semanas 12 y 28, y continuada hasta el parto.

Manejo de la presión arterial

La presión arterial debe controlarse con agentes antihipertensivos:

• Las terapias de 1ra línea para el control de la presión arterial incluyen:
  • Labetalol Labetalol A salicylamide derivative that is a non-cardioselective blocker of beta-adrenergic receptors and alpha-1 adrenergic receptors. Subarachnoid Hemorrhage
  • Hidralazina
  • Nifedipino
• La nitroglicerina puede utilizarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar.
• Medicamentos teratogénicos para la presión arterial (contraindicados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el embarazo):
  • IECA
  • ARA
  • Antagonistas de los LOS Neisseria receptores de mineralocorticoides

Manejo anteparto

• Los LOS Neisseria protocolos exactos varían según el diagnóstico y la edad gestacional.
• Pruebas de bienestar fetal:
  • Pruebas de no estrés seriadas
  • Ultrasonidos seriados para:
    • Crecimiento fetal
    • Evaluación del flujo sanguíneo de la placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity mediante Doppler Doppler Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. Ultrasound (Sonography)
    • Evaluación del volumen de líquido amniótico
  • Evaluaciones periódicas de la progresión de la enfermedad:
    • Presión arterial
    • Preguntar al AL Amyloidosis individuo sobre el desarrollo de los LOS Neisseria síntomas clave de la preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders
    • Laboratorios de preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders

Momento del parto

El momento del parto depende del control de la PA y de la gravedad de la enfermedad. En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum general, las personas deben dar a luz (ya sea por inducción del parto o por parto por cesárea por indicaciones obstétricas estándar) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria siguientes momentos

• Hipertensión crónica: 37-40 semanas de edad gestacional
• Hipertensión gestacional y preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders sin características graves: 37 WGA
• Preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders con características graves y síndrome HELLP:
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el momento del diagnóstico si es ≥ 34 semanas de edad gestacional
  • Basado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el juicio clínico si < 34 semanas de edad gestacional
• Eclampsia Eclampsia Onset of hyperreflexia; seizures; or coma in a previously diagnosed pre-eclamptic patient (pre-eclampsia). Hypertensive Pregnancy Disorders: en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el momento del diagnóstico, independientemente de la edad gestacional
• Nota: Si se anticipa un parto prematuro, está indicado un curso de corticoides para promover la madurez pulmonar del feto.

Manejo intraparto

En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todas las pacientes:

• Manejo intraparto obstétrico estándar
• Monitorización cardiotocográfica fetal continua
• Atención cuidadosa a la administración de fluidos → pacientes con riesgo ↑ de edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar
• Vigilar y tratar las PA de “rango severo” con antihipertensivos IV:
  • Labetalol Labetalol A salicylamide derivative that is a non-cardioselective blocker of beta-adrenergic receptors and alpha-1 adrenergic receptors. Subarachnoid Hemorrhage IV
  • Hidralazina IV

Profilaxis anticonvulsivante:

• Indicada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders con características graves
  • Síndrome de HELLP
  • Eclampsia Eclampsia Onset of hyperreflexia; seizures; or coma in a previously diagnosed pre-eclamptic patient (pre-eclampsia). Hypertensive Pregnancy Disorders
• Generalmente no está indicado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Hipertensión crónica
  • Hipertensión gestacional
  • Preeclampsia Preeclampsia A complication of pregnancy, characterized by a complex of symptoms including maternal hypertension and proteinuria with or without pathological edema. Symptoms may range between mild and severe. Pre-eclampsia usually occurs after the 20th week of gestation, but may develop before this time in the presence of trophoblastic disease. Hypertensive Pregnancy Disorders sin características de severidad
• Medicación: sulfato de magnesio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum infusión intravenosa continua
  • Contraindicaciones: miastenia gravis
  • Rango terapéutico: niveles de magnesio de 4,8-8,4 mg/dL
  • Requiere un ajuste de la dosis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de insuficiencia renal
  • Signos/síntomas de toxicidad por magnesio:
    • Pérdida de reflejos tendinosos profundos (se produce a partir de 8,5-12 mg/dL)
    • Dificultad para respirar (la parálisis pulmonar se produce con 12-16 mg/dL)
    • Paro cardíaco (ocurre a > 30 mg/dL)
  • Antídoto: gluconato de calcio

Tratamiento de la eclampsia Eclampsia Onset of hyperreflexia; seizures; or coma in a previously diagnosed pre-eclamptic patient (pre-eclampsia). Hypertensive Pregnancy Disorders

• Cuidados maternos:
  • Colocar a la paciente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum posición lateral
  • Administrar O₂ suplementario
  • Proteger a la paciente de traumatismos (e.g., elevar las barandillas de la cama)
  • Tratar la hipertensión severa (si está presente) con antihipertensivos IV
  • Sulfato de magnesio (IV si se dispone de acceso, IM si no hay acceso IV)
  • Inicio inmediato del parto
  • La vía (inducción del parto o cesárea) depende de la estabilidad de la madre, la edad gestacional, la evaluación del bienestar fetal y la situación clínica general
  • Nota: la bradicardia fetal puede durar hasta 5 minutos después de una convulsión

Complicaciones

Complicaciones maternas:

• Hemorragia intracraneal
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar
• Insuficiencia renal
• Coagulopatía (e.g., CID)
• ↑ Riesgo de enfermedad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum etapas posteriores de la vida:
  • Enfermedades cardiovasculares y cerebrovasculares
  • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus

Complicaciones fetales:

• Restricción del crecimiento fetal
• Oligohidramnios
• Desprendimiento de placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity
• Estado fetal no tranquilizador que requiere parto por cesárea
• Parto pretérmino

Comparación de los Trastornos Hipertensivos del Embarazo