Gestational Hypertension Flashcards
What is gestational hypertension?
Development of new hypertension in a pregnant woman after 20 weeks gestation
What features are NOT present in gestational hypertension?
- Proteinurea
- Other signs of pre-eclampsia
What is the definition of high blood pressure in pregnancy?
> 140/90 mmHg on two or more separate occasions at least 6 hours apart
What are the maternal risk factors for gestational hypertension?
- Obesity
- <20 or >40 years old
- DM
- Previous gestational hypertension
- Renal disease
- Thrombophilia
- Having donated a kidney
What pregnancy factors increase risk of gestational hypertension?
- Multiple gestation
- Placental abnormalities
What placental abnormalities increase risk of gestational hypertension?
- Hyperplacentosis
- Placental ischaemia
What is hyperplacentosis?
Excessive exposure to chorionic villi
What genetic factors predispose to gestational hypertension?
- Family history of pre-eclampsia
- Black or hispanic
What is the presenting feature of gestational hypertension?
High blood pressure
What symptoms must be absent to suggest gestational hypertension?
Symptoms of pre-eclampsia
What are some symptoms of pre-eclampsia that should not be present in gestational hypertension?
- Significant weight gain
- Peripheral oedema
- Headaches
- Upper abdominal pain
What are the three classifications of gestational hypertension?
- Mild
- Moderate
- Severe
What is mild gestational hypertension?
140-149/90-99 mmHg
What is moderate gestational hypertension?
150-159/100-109 mmHg
What is severe gestational hypertension?
> 160/110 mmHg
Other than BP measurement, what other investigations could be performed for gestational hypertension?
- Urine testing
- Assessment of oedema
- Frequent weight measurements
- Liver and kidney function tests
- Coagulation screen
What does management of gestational hypertension depend on?
Severity
What is the management for mild gestational hypertension?
- BP measure 2x weekly before 32 weeks or at risk of pre-eclampsia and once otherwise
- Check urine for protein at each visit
What is the management for moderate gestational hypertension?
- Monitor BP 2x weekly
- Start labetalol to keep BP <150/80-100
- Dip urine at each visit
- Arrange blood tests
What blood tests should be performed for moderate gestational hypertension?
- FBC
- Electrolytes
- Renal function
- LFTs
What is the initial management for severe gestational hypertension?
- Admit to hospital
What treatment should be given for severe gestational hypertension in hospital?
- Same as moderate
- Monitor BP 4x daily
- Dip urine daily
- Weekly blood tests
What monitoring should patients have for severe gestational hypertension after discharge?
Check BP and urine 2x weekly
What checks for fetal wellbeing should be made in mild/moderate gestational hypertension?
USS at 34 weeks to assess growth and amniotic fluid volume
