HTN In Pregnancy

Question 1

Gestational HTN

Answer 1

Only htn

Question 2

Pre-eclampsia

Answer 2

Htn + proteinuria +- oedema

Hyperreflexia, vomiting, hepatic tenderness, oliguria

Question 3

Eclampsia

Answer 3

Pre-eclampsia + generalised convulsions

Question 4

Classification of pre-eclampsia

Answer 4

Mild: bp> 140/90, proteinuria >0.3g/24hrs
Moderate: diastolic bp 100-110, proteinuria
Severe: >160 systolic, >110 diastolic

Resting bp, 2 readings 6 hours apart

Question 5

Risk factors for pre eclampsia

Answer 5

1st pregnancy
Obesity, DM
FHx, Extremes of mat age
Pre-existing htn
Congenital thrombophilia, anti phospholipid syndrome
SLE, renal disease
Multip preg, hydatiform mole, hydrops fetalis

Question 6

Blood pressure control

Answer 6

Antihypertensives for systolic >160, diastolic > 110
They limit the risk of vascular damage due to uncontrolled htn
Continue for 3/12 post partum
CCB: nifedipine
Alpha + beta blocker: labetalol in acute setting

Question 7

Nifedipine

Answer 7

CCB + vasodilator

SE: flushing, headache, ankle swelling,

Question 8

Labetalol

Answer 8

Alpha + beta blocker
Oral / IV
SE: post htn, tiredness, headaches
1st drug of choice in pre-eclampsia

Question 9

Methyldopa

Answer 9

Decreases sympathetic stimulation
Oral: slow to act, several days to take effect
1st line in essential htn
SE: initial drowsiness

Question 10

CI antihypertensives

Answer 10

Beta blockers e.g. Atenolol: IUGR
ACEi e.g. Ramipril, enalipril: teratogenic, fetal renal failure
Thiazide diuretics: maternal hypovolaemia