Gestational and Chronic hypertension (Complete) Flashcards
Define gestational hypertension
New onset hypertension (> 140/90 mmHg) occuring after 20 weeks gestation with absence of proteinuria
Define chronic hypertension
High blood pressure that predates pregnancy or is diagnosed before 20 weeks of gestation with absence of proteinuria
What BP changes occur in normal pregnancy?
Blood pressure usually falls in the first trimester (particularly the diastolic), and continues to fall until 20-24 weeks
After this time the blood pressure usually increases to pre-pregnancy levels by term
Why is management of gestational and chronic hypertension important?
To reduce risk of complications such as pre-eclampsia and IUGR
What are the clinical features of gestational and chronic hypertension?
Asymptomatic high BP measurements (> 140/90 mmHg)
If symptoms present, more suggestive of pre-eclampsia
When is management of gestational and chronic hypertension indicated?
If there is presence of 1 high-risk factor or 2 moderate risk-factors
What are high risk factors in patients with gestational and chronic hypertension?
Chronic hypertension
Chronic kidney disease
Pre-eclampsia in previous pregnancy
Diabetes
Autoimmune disease
What are moderate risk factors in patients with gestational and chronic hypertension?
First pregnancy
Multiple pregnancy
Pregnancy interval of over 10 years
Age over 40
Family history of pre-eclampsia
What investigations can be considered in patients with chronic/gestational hypertension?
Bedside:
Basic obs: Regular monitoring of BP
Urine dipstick: Check for proteinuria
Bloods:
U&Es: Rule out CKD
Blood glucose: Check for diabetes (risk factor)
Imaging:
Foetal ultrasound: Check for IUGR
What is the management plan for patients with gestational/chronic hypertension?
Conservative/supportive:
Regular monitoring: BP + urinalysis
Medication review: Stop ACEi/ARBs in patients with pre-existing hypertension and swap to oral labetalol (safer)
Medicine:
BP control:
* Oral labetalol: First-line
* Oral nifedipine: Second-line
Aspirin 75mg from 12 weeks gestation: Pre-eclampsia prophylaxis in at-risk patients
How are pregnant women already on anti-hypertensive medication managed?
Stop ACEi/ARB due to increase risk of oligohydraminos in 2nd/3rd trimester and risk congenital malformations in 1st trimester
Replace with pregnancy safe alternative labetalol
Which medication is given to reduce risk of pre-eclampsia during pregnancy?
Aspirin
Improves blood flow to placenta
Aspirin should be given from how many weeks gestation onwards?
12 weeks gestation
Can be stopped after delivery
Labetalol is avoided in which patients?
Patients with asthma
