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A - MSRA Obstetrics [16] > [5] Pre-existing Hypertension In Pregnancy > Flashcards

[5] Pre-existing Hypertension In Pregnancy Flashcards

1
Q

Why is pre-existing hypertension in pregnancy important?

A

It’s a major cause of maternal, fetal, and neonatal morbidity and mortality

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2
Q

What complications are women with pre-existing hypertension in pregnancy at increased risk of?

A
  • Abruptio placentae
  • Cerebrovascular accident
  • Disseminated intravascular coagulation
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3
Q

What complications are the fetus of a woman with pre-existing hypertension in pregnancy at risk of?

A
  • IUGR
  • Prematurity
  • Intrauterine death
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4
Q

What is defined as pre-existing hypertension either at booking or pre-conception?

A

≥ 140/90mmHg

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5
Q

What should be the aim of managing pre-existing hypertension in pregnancy?

A
  • <150/100mmHg

- <140/90mmHg if there is already end organ damage

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6
Q

What does the management of pre-existing hypertension in pregnancy depend on?

A
  • Woman’s BP
  • Gestational age
  • BLood flow to placenta
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7
Q

What is the main recommended type of management for women with pre-existing hypertension in pregnancy where there is not other associated risk factors to mother or fetus?

A

Non-pharmacological management

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8
Q

What are the non pharmacological options for managing pre-existing hypertension in pregnancy?

A
  • Close supervision
  • Limitation of activities
  • Bed rest in left lateral position
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9
Q

In women with pre-existing hypertension in pregnancy that is medicated what should be done?

A

Review the medication and inform the patient of the risks involved with them

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10
Q

Which anti-Hypertension agents should be stopped as soon as possible in pregnancy (or even before if planning)?

A
  • ACE inhibitors

- Angiotensin II antagonists

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11
Q

Why should ACEi and angiotensin II antagonists be stopped as soon as possible in pregnancy?

A

They cause an increased risk of fetal abnormality

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12
Q

What drugs can be used for hypertension in the antenatal/postnatal period?

A
  • Labetalol
  • Nifedipine
  • Methyldopa
  • Enalapril
  • Hydralazine
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13
Q

What is the first line (and only licensed drug) for hypertension in pregnancy?

A

Labetalol

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14
Q

What type of drug is Labetalol ?

A

Beta blocker

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15
Q

When is labetalol contra-indicated?

A
  • Asthma
  • Type 1 diabetes
  • Pheochromocytoma
  • Black, Afro Caribbean women
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16
Q

Why is Labetalol contra indicated in asthma?

A
  • Can cause bronchospasm

- Can make less responsive to inhalers

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17
Q

Why is labetalol contra-indicated in type 1 diabetes?

A

Reduces awareness of hypoglycaemia

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18
Q

Why is labetalol contra-indicated in black, afro-caribbean women?

A

It is not effective

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19
Q

What are the side-effects of labetalol?

A
  • Scalp tingling
  • Headache
  • Weakness
  • Liver damage
  • GI disturbance
20
Q

What sort of drug is nifedipine?

A

Calcium channel blocker

21
Q

What sort of release nifedipine should be given in pregnancy?

A

Modified release

22
Q

What are the two brands of nifedipine used in pregnancy?

A
  • Adipine MR

- Adalat LA

23
Q

How long does adipine MR last?

A

12 hours

24
Q

How often should adipine be administered?

A

BD or as a stat dose

25
Q

When can adipine be used in relation to pregnancy?

A

Antenatally and postnantally

26
Q

How long does adalat LA last?

A

24 hours

27
Q

How often is adalat given?

A

OD

28
Q

What is important about the adalat capsule?

A

It is a husk capsule

29
Q

Why is the husk capsule of adalat important?

A
  • Not for UC or Crohn’s

- May see husk in stool

30
Q

Why is pure nifedipine not given in pregnancy?

A
  • Drops BP too quickly

- Interrupt uterine placental flow

31
Q

When should nifedpine not be given in pregnancy?

A
  • Within 1 month of MI

- Cardiogenic shock

32
Q

What are the side effects of nifedpine?

A
  • May inhibit labour
  • Headaches
  • Flushing
  • Dizziness
  • Palpitations
  • Fluid retention
33
Q

How does methyldopa work as an anti-hypertensive?

A

It is centrally acting

34
Q

When should methyldopa not be given for hypertension in pregnancy?

A
  • Severe depression

- Post-natally

35
Q

Why should methyldopa not be given postnatally?

A

Risk of post-natal depression

36
Q

What are the side effects of methyldopa?

A
  • Depression
  • Tiredness
  • Dry mouth
  • GI disturbance
37
Q

What type of drug is enalalpril?

A

ACE inhibitor

38
Q

When can enalapril be used in regards to pregnancy?

A

POST-NATAL ONLY

39
Q

What are the side-effects of enalapril?

A
  • Dry cough
  • Dyspnoea
  • Depression
40
Q

When should hydralazine be avoided in pregnancy?

A
  • Severe tachycardia
  • Recent MI
  • Idiopathic SLE
  • Before 3rd trimester
41
Q

What are the side-effects of hydralazine?

A
  • Flushing
  • Tachycardia
  • Palpitations
42
Q

Can hydralazine be used in breast feeding?

A

Yes

43
Q

What medication to women with pre-existing hypertension qualify for from 12 weeks?

A

Aspirin 75mg daily

44
Q

What regular test should women with pre-existing hypertension in pregnancy be given?

A

Urine dip for proteinuria

45
Q

If urinalysis in pre-existing hypertension in pregnancy show protein 1+ or greater what additional test should be performed?

A

Spot urinary protein:creatinine ratio or 24-hour urine collection to quantify proteinuria

46
Q

What advice should women with pre-existing hypertension in pregnancy be given?

A

Stop smoking, healthy diet etc.

47
Q

What scans should be offered to women with pre-existing hypertension in pregnancy?

A

USS at 28-30 and 32-34 weeks to assess fetal growth and amniotic fluid volume

A - MSRA Obstetrics [16] (61 decks)

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