9) Maternal Medicine: Hypertension/PET Flashcards
Incidence of hypertensive disorders in pregnancy (hypertension, PET, severe PET, eclampsia)
Hypertension: 8-10%
PET: 5%
Severe PET: 0.5%
Eclampsia : 1/4000
Major and minor risk factors for PET
MAJOR:
- Hypertension
- Previous PIH/PET
- Chronic kidney disease
- T1 or T2 DM
- Autoimmune disorders
MINOR:
- Age > 40
- BMI > 35
- First pregnancy
- Inter-pregnancy interval > 10 years
- Multiple pregnancy
- FHx PET
When to admit?
Gestational hypertension: Only if severe (>16 0/110)
PET:
- Sustained systolic BP >160
- Severe PET (>160/110 or symptoms or fetal concerns)
- Signs of impending eclampsia
- Signs of impending pulmonary oedema
- Abnormal bloods (Cr >90, ALT>70, Plts <150)
- Fetal compromise
Target blood pressures
On treatment 135/85. Treat if persistently >140/90. (All types).
How often to monitor blood pressure?
Chronic hypertension: Weekly if poor control, 2-4 weekly if good control.
Gestational hypertension: 1-2 x per week if mild/moderate, if severe then every 15-30 minutes until <160/110 and then at least QDS whilst inpatient.
PET: Mild/moderate - at least every 48 hours. Severe - every 15-30 minutes until <160/110 and then QDS whilst inpatient.
How often to check urine?
Chronic hypertension: At each review
Gestational hypertension: Mild/moderate: 1-2 x per week. Severe then daily whilst admitted.
PET: Don’t repeat once established.
How often to do blood tests?
Chronic hypertension: Don’t need.
Gestational hypertension: Weekly (any severity).
PET: 2x per week if mild/moderate. 3 x per week if severe.
When to do growth scans?
Chronic hypertension: 28,32,36 weeks.
Gestational hypertension: Mild/moderate - every 2-4 weeks. Severe - every 2 weeks.
PET: Every 2 weeks.
What tests can be done if PET suspected in someone with chronic hypertension or gestational hypertension?
PIGF based testing 20-35 weeks. (Abnormally low in PET)
When to deliver?
Chronic/gestational hypertensives: After 37 weeks provided BP <160/110 unless another indication.
PET: Before 37 weeks if indication (including inability to control BP despite 3 or more classes of drugs in appropriate doses). After 37 weeks plan for delivery within 24-48 hours.
Postnatal BP measurements
Chronic hypertension: Daily D1/D2 and at least once D3-D5.
Review at 2/52 and 6-8/52.
Gestational hypertension:
Same.
PET:
QDS whilst inpatient.
If not medicated then once D3-D5 and alternate days after that if abnormal.
If medicated then every 1-2 days for 2 weeks until off treatment.
When to reduce blood pressure medication postnatal?
If BP <130/80 (consider if less than 140/90)
When can a PET patient be transferred to community?
No symptoms
BP <150/100
Bloods stable (measured 48-72h PN)
What to do if proteinuria still present at 6-8/52 check?
Repeat at 3/12 and if still present refer to renal
How often should BP be checked in labour?
Hourly (and every 15-30 minutes if >160/110)
