HTN in preg

Question 1

RF for Aspirin

Answer 1

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

Question 2

PCR measurement

Answer 2

• Do not use first morning void
• Dip stick- if >+ prot then send PCR
• Do not do 24h urine

PCR>30mg/mmol is PET

Question 3

Chronic HTN early preg

Answer 3

• Change meds to labetalol/nifedipine
• Start aspirin
• Wt mx
• Eat healthy- dont reduce salt in preg

Target BP 135/85

Question 4

PLGF testing

Answer 4

• To rule out PET 20-35w
• > 100- normal
• 12-99- Low, mod risk
• <12- very low, high risk for PET

Question 5

Chronic HTN AN

Answer 5

• Care based on BP
• Check BP and urine every visit
• Serial scans every 4w

Question 6

Chronic HTN birth

Answer 6

• Individually tailored
• If BP well controlled, no need for early delivery

Question 7

Chronic HTN PN care

Answer 7

• Aim BP <140/90
• BP daily for 2 days
• Once between day 3-5
• Then based on medication changes
• GP review at 2 weeks

Question 8

Gestational HTN

Answer 8

• 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

Question 9

Gest HTN birth

Answer 9

• Individual decision based on BP

Question 10

Gest HTN PN

Answer 10

• 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

Question 11

PET symptoms

Answer 11

• Headache
• Visual changes- flashing lights/ blurring
• Severe pain below ribs
• Vomiting- sudden
• Swelling of hands, face, feet

Question 12

Concerning features of PET

Answer 12

• BP>160 systolic
• Cr >90
• ALT >70
• Plts <150
• Impending eclampsia/severe PET
• Pulmonary oedema

Question 13

PET mx

Answer 13

• Treat if BP >140/90
• Admit if any concerns w mum/baby
• Risk assessment- fullPIERS/PREP-s

Bloods- FBC, U+E, LFT, clotting

Question 14

PET monitoring

Answer 14

• 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

Question 15

PET monitoring if Prev PET

Answer 15

• USS bet 28-30w OR 2w before prev onset of PET
• Repeat every 2-4 weeks

Question 16

Severe PET

Answer 16

• Inability to control BP on 3 meds
• Sats <90%
• Deteriorating Plt, U+E, LFT
• Neurological symptoms
• Abruption
• AREDV

Question 17

PET intrapartum

Answer 17

• Hourly BP
• Cont anti HTN meds
• Fluid balance
• No limit on 2nd stage
• MgSO4- if severe PET or prev eclampsia

Question 18

MgSO4 dose

Answer 18

• Loading 4g over 15min
• 1g/h for 24h

Question 19

PET PN (not medicated)

Answer 19

• BP 4x/day as IP
• Once in day 3-5
• If abnormal, repeat alternate days till normal

PN treatment- if BP >150/100

Question 20

PET PN (medicated)

Answer 20

• 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

Question 21

PN bloods

Answer 21

• Plts, LFT, U+E 2-3 days after birth
• If normal, do not need repeating

Question 22

Breast feeding

Answer 22

• Small amount of anti HTN meds can pass in the milk
• Advise pt to monitor baby for drowsiness, lethargy, pallor.

Question 23

Risk of HTN in future preg

Answer 23

See table

Question 24

Other PET risks PN

Answer 24

• Inc risk of HTN, stroke, heart disease

Question 25

Any HTN in prev preg- risk of HTN in this preg

Answer 25

20%

Question 26

PET in prev preg, risk now

Answer 26

PET risk:
33% if del 28-34w
25% if del 34-37w

Question 27

Gest HTN, risk of HTN

Answer 27

10%