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Obstetrics > Gestational Hypertension > Flashcards

Gestational Hypertension Flashcards

1
Q

What is gestational hypertension?

A

Development of new hypertension in a pregnant woman after 20 weeks gestation

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2
Q

What features are NOT present in gestational hypertension?

A
  • Proteinurea

- Other signs of pre-eclampsia

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3
Q

What is the definition of high blood pressure in pregnancy?

A

> 140/90 mmHg on two or more separate occasions at least 6 hours apart

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4
Q

What are the maternal risk factors for gestational hypertension?

A
  • Obesity
  • <20 or >40 years old
  • DM
  • Previous gestational hypertension
  • Renal disease
  • Thrombophilia
  • Having donated a kidney
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5
Q

What pregnancy factors increase risk of gestational hypertension?

A
  • Multiple gestation

- Placental abnormalities

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6
Q

What placental abnormalities increase risk of gestational hypertension?

A
  • Hyperplacentosis

- Placental ischaemia

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7
Q

What is hyperplacentosis?

A

Excessive exposure to chorionic villi

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8
Q

What genetic factors predispose to gestational hypertension?

A
  • Family history of pre-eclampsia

- Black or hispanic

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9
Q

What is the presenting feature of gestational hypertension?

A

High blood pressure

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10
Q

What symptoms must be absent to suggest gestational hypertension?

A

Symptoms of pre-eclampsia

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11
Q

What are some symptoms of pre-eclampsia that should not be present in gestational hypertension?

A
  • Significant weight gain
  • Peripheral oedema
  • Headaches
  • Upper abdominal pain
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12
Q

What are the three classifications of gestational hypertension?

A
  • Mild
  • Moderate
  • Severe
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13
Q

What is mild gestational hypertension?

A

140-149/90-99 mmHg

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14
Q

What is moderate gestational hypertension?

A

150-159/100-109 mmHg

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15
Q

What is severe gestational hypertension?

A

> 160/110 mmHg

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16
Q

Other than BP measurement, what other investigations could be performed for gestational hypertension?

A
  • Urine testing
  • Assessment of oedema
  • Frequent weight measurements
  • Liver and kidney function tests
  • Coagulation screen
17
Q

What does management of gestational hypertension depend on?

A

Severity

18
Q

What is the management for mild gestational hypertension?

A
  • BP measure 2x weekly before 32 weeks or at risk of pre-eclampsia and once otherwise
  • Check urine for protein at each visit
19
Q

What is the management for moderate gestational hypertension?

A
  • Monitor BP 2x weekly
  • Start labetalol to keep BP <150/80-100
  • Dip urine at each visit
  • Arrange blood tests
20
Q

What blood tests should be performed for moderate gestational hypertension?

A
  • FBC
  • Electrolytes
  • Renal function
  • LFTs
21
Q

What is the initial management for severe gestational hypertension?

A
  • Admit to hospital
22
Q

What treatment should be given for severe gestational hypertension in hospital?

A
  • Same as moderate
  • Monitor BP 4x daily
  • Dip urine daily
  • Weekly blood tests
23
Q

What monitoring should patients have for severe gestational hypertension after discharge?

A

Check BP and urine 2x weekly

24
Q

What checks for fetal wellbeing should be made in mild/moderate gestational hypertension?

A

USS at 34 weeks to assess growth and amniotic fluid volume

25
Q

What checks for fetal wellbeing should be made in severe gestational hypertension?

A

CTG at diagnosis and USS and umbilical artery doppler if conservative management planned

26
Q

When should a CTG be repeated in severe gestational hypertension?

A

If woman reports any:

  • Change in fetal movement
  • Vaginal bleeding
  • Abdominal pain
  • Deterioration in maternal condition
27
Q

What monitoring should take after birth for gestational hypertension?

A
  • BP for first 2 days

- BP once between days 3-5

28
Q

When should antihypertensive medication be stopped?

A

Reduce as BP falls after birth

29
Q

What changes should be made if treating gestational hypertension with methyldopa?

A

Switch at most 2 days after delivery

30
Q

What % of women with gestational hypertension before 34 weeks will go on to develop pre-eclampsia?

A

40%

31
Q

What are hypertensive disorders of pregnancy (including gestational hypertension) a risk factor for?

A

Cardiovascular disease in later life

32
Q

What future management is recommended after delivery with gestational hypertension?

A
  • Lifestyle modification
  • Regular BP control
  • Control of metabolic factors
33
Q

Why is ongoing management recommended after gestational hypertension?

A

To reduce the risk of further complications in future pregnancies and reduce cardiovascular risk

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