Chronic HTN in pregnancy

Question 1

What is the pre-conception management of women with chronic HTN?

Answer 1

Stop
ACEi
ARBs
Thiazides
Thiazide-like diuretics
Contact GP to arrange alternative within 2 days +ve pregnancy test

Question 2

What antihypertensives can be used in pregnancy?

Answer 2

1st: Labetalol
2nd: Nifedipine (1st in Asthmatics)
3rd: Methyldopa

Question 3

What is the antenatal management of women with chronic HTN?

Answer 3

Advice regarding salt intake, exercise, lifestyle

BP monitoring weekly if HTN poorly controlled, every 2-4w if well controlled

Aim <135/85

Serial growth scans every 4w from 28-36w

Question 4

What is the pharmacological antenatal management of women with chronic HTN?

Answer 4

Antihypertensive e.g. Labetalol
Low dose aspirin 75mg OD from 12w

Question 5

What is the intrapartum management of women with chronic HTN?

Answer 5

If BP <160/110 senior input required

Question 6

What is the postnatal management of women with chronic HTN?

Answer 6

BP monitoring daily for first 2d after birth

At least once between day 3-5

As clinically indicated if antihypertensive Tx is changed after birth

Aim to keep BP <140/90

Arrange FU with GP or specialist for antihypertensive review

Question 7

Which antihypertensive drug must be stopped within 2 days of birth and changed? Why?

Answer 7

Methyldopa
Increases risk of postnatal depression

Question 8

Which antihypertensives are recommended postpartum?

Answer 8

Enalapril

Nifedipine (Afrocarribean)