HTN Pregnancy Flashcards
Hypertension dx criteria
Systolic BP of 140 mm Hg or greater OR diastolic BP of
90 mm Hg or greater
• Present on at LEAST 2 occasions (at least 4 hours apart BUT no
more than 1 week apart)
• Appropriate BP cuff must be used (bladder should encircle 80% or
more of the arm)
• Patients should be in upright position
• 10 minute+ rest period
• Chronic hypertension:
HTN diagnoses prior to pregnancy,
prior to 20 weeks gestation, or HTN that does not resolve
by 12 weeks PP
• Gestational hypertension
HTN developing after 20 weeks
gestation or during first 24 hours PP without proteinuria or
other signs of preeclampsia
Preeclampsia/Eclampsia
HTN typically developing after
20 weeks gestation with proteinuria; eclampsia is seizure
activity without other identifiable causes
46% of women with gestational HTN will develop
preeclampsia
Higher rates of c/s and pregnancy complications when
women have
gestational HTN
severe gestational HTN
: systolic 160 mm Hg and/or diastolic 110 mm Hg
for at least 6 hours without proteinuria
gestational HTN is often seen as
“provisional” diagnosis until pregnancy is
complete
• Progress to preeclampsia v. chronic HTN v. complete resolution
Mild gestational HTN generally allows for
expectant
management
• Lifestyle changes can help decrease mild HTN
Medications used to control severe gestational HTN
Similar management as preeclampsia
follow-up
Weekly/biweekly office visits/BP checks
• NST/BPP weekly or biweekly
Secondary HTN: 10% of pregnancies
• Associated with
renal disease, endocrine disease, coarctation of
the aorta, collagen vascular disease
chronic htn increases risk
for preeclampsia, abruption, IUGR, PTL
and delivery
chronic htn increases risk for fetal
demise if uncontroleed
dx of chronic htn
• Made prior to pregnancy or in first weeks of pregnancy
• Discussion about pregnancy and HTN should ideally be
done at preconception visit
Management of Chronic HTN - Lifestyle
- Diet (particularly salt intake)
* Alcohol and smoking
Management of Chronic HTN - medicaitons
- Methyldopa
- Labetalol
- Thiazide diuretic
- Nifedipine
chronic htn testing
• Weekly NST/BPP starting at ~32 weeks
• Growth ultrasound and AFI every 4 weeks in 3rd trimester
• Consider induction of labor (IOL) based on severity of HTN and antenatal
testing results
you should do what as an NP
Consult/Collaborate for HTN cases • Severe HTN should be managed by MD colleague • Consult • Collaborate • Refer/Transfer
bottom line
• Consult • Collaborate • Transfer • Look at the entire clinical picture to make decisions and always consult on HTN cases!
