eL17 Hypertension in pregnancy Flashcards
Chronic HTN
Pre-existing HTN/ new onset HTN
Before 20 weeks gestation
Proteinuria absent
Gestational HTN
New onset HTN
After 20 weeks gestation
Proteinuria absent
Pre-eclampsia
New onset HTN
After 20 weeks gestation
New onset of ANY of the following:
a. Proteinuria (usually present)
b. Signs of end-organ dysfunction
c. Uteroplacental dysfunction → fetal growth restriction
Chronic HTN with superimposed preeclampsia
Chronic HTN
Before 20 weeks gestation
Proteinuria present (new onset)
proteinuria tests
24h urinary protein (UTP) ≥ 300 mg
Dipstick protein ≥ 2+ → to match colour against standard
Urine protein: creatinine ratio (uPCR) > 0.3 mg/dL
Signs of end-organ damage
Platelet count < 100
LFTs > 2x ULN
Doubling of SCr in absence of other renal diseases
Pulmonary edema ⇒ cardiac & lungs dysfunction
Neurological complications ⇒ severe symptoms
BP threshold to initiate treatment
≥ 140/90 mmHg ⇒ to start treatment
Treatment of hypertension in pregnancy
labetalol
Nifedipine ER
Hydrochlorothiazide
Methyldopa
Hydralazine
labetalol monitoring
bronchoconstrictive effects & bradycardia
Nifedipine ER monitoring
pedal edema, flushing (due to vasodilation), headaches
Hydrochlorothiazide purpose & concerns
to reduce fluid volume in body to reduce BP
potential interference with normal blood volume expansion during pregnancy
Methyldopa AE
sedation & dizziness
Hydralazine AE
N/V, palpitation, flushing, headache, tremor
Prevention of pre-eclampsia
Low dose aspirin
Aspirin indications
High risk patients:
HTN on previous pregnancy, multifetal gestations (twins/ triplets), autoimmune diseases, DM, CKD
