[17] Gestational Hypertension Flashcards
What is gestational hypertension?
Development of new hypertension in a pregnant woman after 20 weeks gestation
What features are NOT present in gestational hypertension?
- Proteinurea
- Other signs of pre-eclampsia
What is the definition of high blood pressure in pregnancy?
> 140/90 mmHg on two or more separate occasions at least 6 hours apart
What are the maternal risk factors for gestational hypertension?
- Obesity
- <20 or >40 years old
- DM
- Previous gestational hypertension
- Renal disease
- Thrombophilia
- Having donated a kidney
What pregnancy factors increase risk of gestational hypertension?
- Multiple gestation
- Placental abnormalities
What placental abnormalities increase risk of gestational hypertension?
- Hyperplacentosis
- Placental ischaemia
What is hyperplacentosis?
Excessive exposure to chorionic villi
What genetic factors predispose to gestational hypertension?
- Family history of pre-eclampsia
- Black or hispanic
What is the presenting feature of gestational hypertension?
High blood pressure
What symptoms must be absent to suggest gestational hypertension?
Symptoms of pre-eclampsia
What are some symptoms of pre-eclampsia that should not be present in gestational hypertension?
- Significant weight gain
- Peripheral oedema
- Headaches
- Upper abdominal pain
What are the three classifications of gestational hypertension?
- Mild
- Moderate
- Severe
What is mild gestational hypertension?
140-149/90-99 mmHg
What is moderate gestational hypertension?
150-159/100-109 mmHg
What is severe gestational hypertension?
> 160/110 mmHg
Other than BP measurement, what other investigations could be performed for gestational hypertension?
- Urine testing
- Assessment of oedema
- Frequent weight measurements
- Liver and kidney function tests
- Coagulation screen
What does management of gestational hypertension depend on?
Severity
What is the management for mild gestational hypertension?
- BP measure 2x weekly before 32 weeks or at risk of pre-eclampsia and once otherwise
- Check urine for protein at each visit
What is the management for moderate gestational hypertension?
- Monitor BP 2x weekly
- Start labetalol to keep BP <150/80-100
- Dip urine at each visit
- Arrange blood tests
What blood tests should be performed for moderate gestational hypertension?
- FBC
- Electrolytes
- Renal function
- LFTs
What is the initial management for severe gestational hypertension?
- Admit to hospital
What treatment should be given for severe gestational hypertension in hospital?
- Same as moderate
- Monitor BP 4x daily
- Dip urine daily
- Weekly blood tests
What monitoring should patients have for severe gestational hypertension after discharge?
Check BP and urine 2x weekly
What checks for fetal wellbeing should be made in mild/moderate gestational hypertension?
USS at 34 weeks to assess growth and amniotic fluid volume
What checks for fetal wellbeing should be made in severe gestational hypertension?
CTG at diagnosis and USS and umbilical artery doppler if conservative management planned
When should a CTG be repeated in severe gestational hypertension?
If woman reports any:
- Change in fetal movement
- Vaginal bleeding
- Abdominal pain
- Deterioration in maternal condition
What monitoring should take after birth for gestational hypertension?
- BP for first 2 days
- BP once between days 3-5
When should antihypertensive medication be stopped?
Reduce as BP falls after birth
What changes should be made if treating gestational hypertension with methyldopa?
Switch at most 2 days after delivery
What % of women with gestational hypertension before 34 weeks will go on to develop pre-eclampsia?
40%
What are hypertensive disorders of pregnancy (including gestational hypertension) a risk factor for?
Cardiovascular disease in later life
What future management is recommended after delivery with gestational hypertension?
- Lifestyle modification
- Regular BP control
- Control of metabolic factors
Why is ongoing management recommended after gestational hypertension?
To reduce the risk of further complications in future pregnancies and reduce cardiovascular risk
