HTN in preg Flashcards
RF for Aspirin
High RF:
- HTN in prev preg
- Chronic HTN
- Renal disease
- Diabetes
- Autoimmune condition
Mod RF (2 or >):
- P0
- Age >=40
- BMI>35
- Twins or <
- Preg gap 10 years
- Mum/sister w PET
PCR measurement
- Do not use first morning void
- Dip stick- if >+ prot then send PCR
- Do not do 24h urine
PCR>30mg/mmol is PET
Chronic HTN early preg
- Change meds to labetalol/nifedipine
- Start aspirin
- Wt mx
- Eat healthy- dont reduce salt in preg
Target BP 135/85
PLGF testing
- To rule out PET 20-35w
- > 100- normal
- 12-99- Low, mod risk
- <12- very low, high risk for PET
Chronic HTN AN
- Care based on BP
- Check BP and urine every visit
- Serial scans every 4w
Chronic HTN birth
- Individually tailored
- If BP well controlled, no need for early delivery
Chronic HTN PN care
- Aim BP <140/90
- BP daily for 2 days
- Once between day 3-5
- Then based on medication changes
- GP review at 2 weeks
Gestational HTN
- Treat if BP >140/90
- Admit if BP >160/110
- Aim BP <135/85 w meds
- Bloods- FBC, U+E, LFT
Repeat weekly - BP and urine once/twice per week
- Serial scans
- PLGF on 1 occassion if ?PET
Gest HTN birth
- Individual decision based on BP
Gest HTN PN
- Aim BP <150/100
- BP daily for 2 days
- Once between day 3-5
- Stop meds if BP <130/80
- If still medicated, GP rv in 2w
PET symptoms
- Headache
- Visual changes- flashing lights/ blurring
- Severe pain below ribs
- Vomiting- sudden
- Swelling of hands, face, feet
Concerning features of PET
- BP>160 systolic
- Cr >90
- ALT >70
- Plts <150
- Impending eclampsia/severe PET
- Pulmonary oedema
PET mx
- Treat if BP >140/90
- Admit if any concerns w mum/baby
- Risk assessment- fullPIERS/PREP-s
Bloods- FBC, U+E, LFT, clotting
PET monitoring
- BP weekly
- Urine PCR- only repeat if new symptoms
- Bloods 2x/w, 3x if BP was >160/110
- USS at diagnosis then every 2 weeks
PET monitoring if Prev PET
- USS bet 28-30w OR 2w before prev onset of PET
- Repeat every 2-4 weeks
Severe PET
- Inability to control BP on 3 meds
- Sats <90%
- Deteriorating Plt, U+E, LFT
- Neurological symptoms
- Abruption
- AREDV
PET intrapartum
- Hourly BP
- Cont anti HTN meds
- Fluid balance
- No limit on 2nd stage
- MgSO4- if severe PET or prev eclampsia
MgSO4 dose
- Loading 4g over 15min
- 1g/h for 24h
PET PN (not medicated)
- BP 4x/day as IP
- Once in day 3-5
- If abnormal, repeat alternate days till normal
PN treatment- if BP >150/100
PET PN (medicated)
- Cont treatment/change to enalapril or amlodipine
- Adjust if BP <130/80
- BP 4x/day as IP
- Every 1-2days for 2 weeks till not medicated
- If still medicated at 2 weeks- GP review
- Urine dip- with GP at 6w, if still prot +, for further assessment
PN bloods
- Plts, LFT, U+E 2-3 days after birth
- If normal, do not need repeating
Breast feeding
- Small amount of anti HTN meds can pass in the milk
- Advise pt to monitor baby for drowsiness, lethargy, pallor.
Risk of HTN in future preg
See table
Other PET risks PN
- Inc risk of HTN, stroke, heart disease
Any HTN in prev preg- risk of HTN in this preg
20%
PET in prev preg, risk now
PET risk:
33% if del 28-34w
25% if del 34-37w
Gest HTN, risk of HTN
10%
