HTN In Pregnancy

Question 1

GHTN BP 140/90 - 159/109 management

Answer 1

Do not routinely admit to hospital
Offer pharmacological treatment if BP > 140/90
Aim for BP of 135/87 or less once on treatment

Question 2

GTN severe HTN 160/100 management

Answer 2

Admit, but if BP falls below 160/110 then manage as for HTN
Offer pharmacological treatment to all women
Aim for BP of 135/85 or less

Question 3

When to start antihypertensives and what to aim for

Answer 3

Above 140/90, aim for below 135/85

Question 4

Monitoring for BP 140/90-159/109

Answer 4

Once / twice weekly (depending on BP) monitoring until BP is 135/85 or less

Urine dip once or twice week (with BP measurement)

Measure FBC, LFT, U&Es at presentation and then weekly

Carry out PIGF testing on 1 occasion if there is suspicion of PET

Question 5

Monitoring of BP 160/110 or more

Answer 5

Measure BP 15-30 minutes until BP < 160/110

Daily urine dip admitted

Measure FBC, LFT, U&E at presentation and then weekly

Carry out PIGF testing on 1 occasion if there is suspicion of pre-eclampsia

Question 6

Fetal assessment for HTN 140/90 - 159/109

Answer 6

Offer fetal heart auscultation at every antenatal appointment

Carry out USS assessment of the fetus at diagnosis, and, if normal, repeat every 2-4 weeks, if clinically indicated.

Carry out a CTG only if clinically indicated

Question 7

Fetal assessment for Blood pressure 160/110

Answer 7

Offer fetal heart auscultation at every antenatal appointment

Carry out USS assessment of the fetus at diagnosis, and, if normal, repeat every 2 weeks, if severe hypertension persists

Carry out a CTG at diagnosis and then only if clinically indicated

Question 8

Management of HTN with PET
BP 140/90 - 159/109

Answer 8

Admit if any clinical concerns for the wellbeing of the woman or baby, or if high risk of adverse events suggested by the fullPIERS or PREP-S risk prediction models

Offer pharmacological treatment if BP remains above 140/90

Aim for BP of 135/85 or less

Question 9

Management of severe HTN with PET
BP > equal 160/110

Answer 9

Admit, but if BP falls below 160/110 then manage as HTN

Offer pharmacological treatment to all
Women

Aim for BP of 135/85 or less

Question 10

Management of PET HTN
140/90 - 159/109

Answer 10

At least every 48 hours, and more frequently if the woman is admitted to hospital

Only repeat urine dipstick if clinically indicated, if signs and symptoms develop or if there is uncertainty over diagnosis

Measure FBC, LFTs, U&Es

Question 11

Severe HTN with PET
160/110 management

Answer 11

BP measured every 14-30 minutes until BP is less than 160/110, then at least 4 times daily while the woman is IP, depending on clinical circumstances

Urine dip - only repeat as per mild / mod HTN

measure FBC, U&Es, LFTs 3 times a week

Question 12

Frequency of blood tests in HTN / PET

Answer 12

HTN OW
MILD / MOD PET TW
Sev PET ThW

Question 13

Fetal assessment in Mild / Mod PET
140/90-159/109

Answer 13

Offer fetal heart auscultation at every antenatal appointment

Carry out USS assessment of the fetus at diagnosis, and, if normal, repeat every 2 weeks

Carry out a CTG at diagnosis and then only if clinically indicated

Question 14

Fetal assessment for severe HTN PET
BP 160/110

Answer 14

Offer fetal heart auscultation at every antenatal appointment

Carry out USS assessment of the fetus at diagnosis, and, if normal, repeat every 2 weeks

Carry out a CTG at diagnosis and then only if clinically indicated

Question 15

Cut off for PET delivery

Answer 15

Never beyond 37/40
Initiate delivery within 24/48 hours

Question 16

Level 3 care PET

Answer 16

Severe PET
Needing ventilation

Question 17

Level 2 Care PET

Answer 17

Eclampsia
HELLP Syndrome
Haemorrhage
Hyperkalaemia
Severe oliguria
Coagulation support
IV antihypertensives
Initial stabilisation of severe HTN
evidence of cardiac failure
Abnormal neurology

Question 18

Level 1 care

Answer 18

PET with HTN
Ongoing conservative antenatal management of severe preterm HTN
Step down treatment after the birth

Question 19

Hypertension recurrence
Any HTN in pregnancy

HTN
PET

Answer 19

HTN - 21% (1/5)
PET - 14% (1/7)

Question 20

Hypertension recurrence
PET

HTN
PET

Answer 20

Any HTN (1/5) 20%
PET up to approximately 16% (1/6)

If birth was at 28-34 weeks then 33% (1/3)

If birth was 34-37/40 23% (1/4)

Question 21

Hypertension recurrence
GHTN

Answer 21

HTN 22% (1/5)

PET 7%
(1/14)

Question 22

High risk - aspirin in pregnancy

Answer 22

HTN previous pregnancy
CKD chronic HTN
T1/ T2 DM
Autoimmune disease (SLE, APLS)

Question 23

Moderate risk - aspirin

Answer 23

First pregnancy
Above or older than 40 years
Pregnancy interval more than 10 years
BMI equal to or above 35 at first visit
Family history of PET
Multiple pregnancy

Question 24

How many high risks for aspirin?

How many moderate risks for aspirin?

Answer 24

1

2

Question 25

antihypertensives sequence

Answer 25

Labetalol

Nifedipine

Methyldopa

Question 26

Postnatal treatment of hypertension sequence

Answer 26

Enalapril

Nifedipine

Labetalol

Question 27

Chronic hypertension follow up

Answer 27

6-8 weeks after birth
Daily BP first 2 days after birth
At least once between day 3 and day 5 after birth
As clinically indicated if antihypertensive treatment is changed after birth

Question 28

GHTN follow up

Answer 28

6-8 weeks after birth
Daily BP first 2 days after birth
At least once between day 3 and day 5 after birth
As clinically indicated if antihypertensive treatment is changed after birth

Question 29

PET F/U

Answer 29

6-8 weeks after birth
Daily BP first 2 days after birth
At least once between day 3 and day 5 after birth
As clinically indicated if antihypertensive treatment is changed after birth

Question 30

Target BPs

Answer 30

Start aHTNs if 140/90
Target BP once on aHTNs 135/85
Chronic HTN after delivery <140/90

Question 31

Urine check in PET

Answer 31

Automated Urine reagent strip

SPOT protein >30

24 hours >300mg