[5] Pre-existing Hypertension In Pregnancy Flashcards
Why is pre-existing hypertension in pregnancy important?
It’s a major cause of maternal, fetal, and neonatal morbidity and mortality
What complications are women with pre-existing hypertension in pregnancy at increased risk of?
- Abruptio placentae
- Cerebrovascular accident
- Disseminated intravascular coagulation
What complications are the fetus of a woman with pre-existing hypertension in pregnancy at risk of?
- IUGR
- Prematurity
- Intrauterine death
What is defined as pre-existing hypertension either at booking or pre-conception?
≥ 140/90mmHg
What should be the aim of managing pre-existing hypertension in pregnancy?
- <150/100mmHg
- <140/90mmHg if there is already end organ damage
What does the management of pre-existing hypertension in pregnancy depend on?
- Woman’s BP
- Gestational age
- BLood flow to placenta
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?
Non-pharmacological management
What are the non pharmacological options for managing pre-existing hypertension in pregnancy?
- Close supervision
- Limitation of activities
- Bed rest in left lateral position
In women with pre-existing hypertension in pregnancy that is medicated what should be done?
Review the medication and inform the patient of the risks involved with them
Which anti-Hypertension agents should be stopped as soon as possible in pregnancy (or even before if planning)?
- ACE inhibitors
- Angiotensin II antagonists
Why should ACEi and angiotensin II antagonists be stopped as soon as possible in pregnancy?
They cause an increased risk of fetal abnormality
What drugs can be used for hypertension in the antenatal/postnatal period?
- Labetalol
- Nifedipine
- Methyldopa
- Enalapril
- Hydralazine
What is the first line (and only licensed drug) for hypertension in pregnancy?
Labetalol
What type of drug is Labetalol ?
Beta blocker
When is labetalol contra-indicated?
- Asthma
- Type 1 diabetes
- Pheochromocytoma
- Black, Afro Caribbean women
Why is Labetalol contra indicated in asthma?
- Can cause bronchospasm
- Can make less responsive to inhalers
Why is labetalol contra-indicated in type 1 diabetes?
Reduces awareness of hypoglycaemia
Why is labetalol contra-indicated in black, afro-caribbean women?
It is not effective
What are the side-effects of labetalol?
- Scalp tingling
- Headache
- Weakness
- Liver damage
- GI disturbance
What sort of drug is nifedipine?
Calcium channel blocker
What sort of release nifedipine should be given in pregnancy?
Modified release
What are the two brands of nifedipine used in pregnancy?
- Adipine MR
- Adalat LA
How long does adipine MR last?
12 hours
How often should adipine be administered?
BD or as a stat dose
When can adipine be used in relation to pregnancy?
Antenatally and postnantally
How long does adalat LA last?
24 hours
How often is adalat given?
OD
What is important about the adalat capsule?
It is a husk capsule
Why is the husk capsule of adalat important?
- Not for UC or Crohn’s
- May see husk in stool
Why is pure nifedipine not given in pregnancy?
- Drops BP too quickly
- Interrupt uterine placental flow
When should nifedpine not be given in pregnancy?
- Within 1 month of MI
- Cardiogenic shock
What are the side effects of nifedpine?
- May inhibit labour
- Headaches
- Flushing
- Dizziness
- Palpitations
- Fluid retention
How does methyldopa work as an anti-hypertensive?
It is centrally acting
When should methyldopa not be given for hypertension in pregnancy?
- Severe depression
- Post-natally
Why should methyldopa not be given postnatally?
Risk of post-natal depression
What are the side effects of methyldopa?
- Depression
- Tiredness
- Dry mouth
- GI disturbance
What type of drug is enalalpril?
ACE inhibitor
When can enalapril be used in regards to pregnancy?
POST-NATAL ONLY
What are the side-effects of enalapril?
- Dry cough
- Dyspnoea
- Depression
When should hydralazine be avoided in pregnancy?
- Severe tachycardia
- Recent MI
- Idiopathic SLE
- Before 3rd trimester
What are the side-effects of hydralazine?
- Flushing
- Tachycardia
- Palpitations
Can hydralazine be used in breast feeding?
Yes
What medication to women with pre-existing hypertension qualify for from 12 weeks?
Aspirin 75mg daily
What regular test should women with pre-existing hypertension in pregnancy be given?
Urine dip for proteinuria
If urinalysis in pre-existing hypertension in pregnancy show protein 1+ or greater what additional test should be performed?
Spot urinary protein:creatinine ratio or 24-hour urine collection to quantify proteinuria
What advice should women with pre-existing hypertension in pregnancy be given?
Stop smoking, healthy diet etc.
What scans should be offered to women with pre-existing hypertension in pregnancy?
USS at 28-30 and 32-34 weeks to assess fetal growth and amniotic fluid volume