118 Obstetrics and Gynecology Board Review •••
❍ What are the criteria for diagnosis of severe preeclampsia?
One or more of the following:
- Systolic blood pressure of 160 mmHg or higher or diastolic 110 mmHg or higher on two occasions at least
6 hours apart while the patient is on bed rest. - Proteinuria of 5000 mg or higher in a 24-hour urine specimen or 3+ or greater on two random urine samples
collected at least 4 hours apart. - Oliguria of <500 mL in 24 hours; cerebral or visual disturbances.
- Pulmonary edema or cyanosis.
- Epigastric or right upper quadrant pain.
- Impaired liver function.
- Thrombocytopenia.
- Fetal growth restriction.
❍ What is the diastolic blood pressure?
The pressure when the sound disappears (Korotkoff phase V).
❍ What is an appropriate size cuff?
Length 1.5 times upper arm circumference or a cuff with a bladder that encircles 80% or more of the arm.
❍ How should the blood pressure be measured?
In an upright position (or left lateral recumbent position with the patient’s arm at the level of the heart) after
10 minutes or longer rest period.
❍ What external factors may cause a falsely elevated blood pressure measurement?
Elevation limited to the clinical setting (white-coat syndrome) and use of tobacco or caffeine <30 minutes prior to
the measurement.
❍ What is the incidence of preeclampsia?
5% to 8%.
❍ What are some risk factors for preeclampsia?
First pregnancy, multifetal gestations, preeclampsia in a previous pregnancy, chronic hypertension, pregestational
diabetes, vascular and connective tissue disease, nephropathy, antiphospholipid antibody syndrome, obesity, age
35 years or older, and African American race.
❍ What is the pathophysiology of preeclampsia?
Vascular endothelial damage with vasospasm, transudation of plasma, and ischemic and thrombotic sequelae.
❍ Name a few suggested etiologies for the development of preeclampsia.
Abnormal (incomplete) trophoblastic invasion of uterine vessels, immunological intolerance of fetoplacental
tissue, maladaption to inflammatory or cardiovascular changes of pregnancy, and dietary deficiencies and genetic
influence.
❍ What term is used to describe the arterial changes noted in preeclampsia?
Atherosis.