HTN in preg Flashcards
1
Q
RF for Aspirin
A
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
2
Q
PCR measurement
A
- Do not use first morning void
- Dip stick- if >+ prot then send PCR
- Do not do 24h urine
PCR>30mg/mmol is PET
3
Q
Chronic HTN early preg
A
- Change meds to labetalol/nifedipine
- Start aspirin
- Wt mx
- Eat healthy- dont reduce salt in preg
Target BP 135/85
4
Q
PLGF testing
A
- To rule out PET 20-35w
- > 100- normal
- 12-99- Low, mod risk
- <12- very low, high risk for PET
5
Q
Chronic HTN AN
A
- Care based on BP
- Check BP and urine every visit
- Serial scans every 4w
6
Q
Chronic HTN birth
A
- Individually tailored
- If BP well controlled, no need for early delivery
7
Q
Chronic HTN PN care
A
- Aim BP <140/90
- BP daily for 2 days
- Once between day 3-5
- Then based on medication changes
- GP review at 2 weeks
8
Q
Gestational HTN
A
- 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
9
Q
Gest HTN birth
A
- Individual decision based on BP
10
Q
Gest HTN PN
A
- 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
11
Q
PET symptoms
A
- Headache
- Visual changes- flashing lights/ blurring
- Severe pain below ribs
- Vomiting- sudden
- Swelling of hands, face, feet
12
Q
Concerning features of PET
A
- BP>160 systolic
- Cr >90
- ALT >70
- Plts <150
- Impending eclampsia/severe PET
- Pulmonary oedema
13
Q
PET mx
A
- Treat if BP >140/90
- Admit if any concerns w mum/baby
- Risk assessment- fullPIERS/PREP-s
Bloods- FBC, U+E, LFT, clotting
14
Q
PET monitoring
A
- 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
15
Q
PET monitoring if Prev PET
A
- USS bet 28-30w OR 2w before prev onset of PET
- Repeat every 2-4 weeks
16
Q
Severe PET
A
- Inability to control BP on 3 meds
- Sats <90%
- Deteriorating Plt, U+E, LFT
- Neurological symptoms
- Abruption
- AREDV
17
Q
PET intrapartum
A
- Hourly BP
- Cont anti HTN meds
- Fluid balance
- No limit on 2nd stage
- MgSO4- if severe PET or prev eclampsia
18
Q
MgSO4 dose
A
- Loading 4g over 15min
- 1g/h for 24h
19
Q
PET PN (not medicated)
A
- BP 4x/day as IP
- Once in day 3-5
- If abnormal, repeat alternate days till normal
PN treatment- if BP >150/100
20
Q
PET PN (medicated)
A
- 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
21
Q
PN bloods
A
- Plts, LFT, U+E 2-3 days after birth
- If normal, do not need repeating
22
Q
Breast feeding
A
- Small amount of anti HTN meds can pass in the milk
- Advise pt to monitor baby for drowsiness, lethargy, pallor.
23
Q
Risk of HTN in future preg
A
See table
24
Q
Other PET risks PN
A
- Inc risk of HTN, stroke, heart disease
25
Any HTN in prev preg- risk of HTN in this preg
20%
26
PET in prev preg, risk now
PET risk:
33% if del 28-34w
25% if del 34-37w
27
Gest HTN, risk of HTN
10%