HTN Pregnancy

Question 1

Hypertension dx criteria

Answer 1

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

Question 2

• Chronic hypertension:

Answer 2

HTN diagnoses prior to pregnancy,
prior to 20 weeks gestation, or HTN that does not resolve
by 12 weeks PP

Question 3

• Gestational hypertension

Answer 3

HTN developing after 20 weeks
gestation or during first 24 hours PP without proteinuria or
other signs of preeclampsia

Question 4

Preeclampsia/Eclampsia

Answer 4

HTN typically developing after
20 weeks gestation with proteinuria; eclampsia is seizure
activity without other identifiable causes

Question 5

46% of women with gestational HTN will develop

Answer 5

preeclampsia

Question 6

Higher rates of c/s and pregnancy complications when

women have

Answer 6

gestational HTN

Question 7

severe gestational HTN

Answer 7

: systolic 160 mm Hg and/or diastolic 110 mm Hg

for at least 6 hours without proteinuria

Question 8

gestational HTN is often seen as

Answer 8

“provisional” diagnosis until pregnancy is
complete
• Progress to preeclampsia v. chronic HTN v. complete resolution

Question 9

Mild gestational HTN generally allows for

Answer 9

expectant
management
• Lifestyle changes can help decrease mild HTN

Question 10

Medications used to control severe gestational HTN

Answer 10

Similar management as preeclampsia

Question 11

follow-up

Answer 11

Weekly/biweekly office visits/BP checks

• NST/BPP weekly or biweekly

Question 12

Secondary HTN: 10% of pregnancies

• Associated with

Answer 12

renal disease, endocrine disease, coarctation of

the aorta, collagen vascular disease

Question 13

chronic htn increases risk

Answer 13

for preeclampsia, abruption, IUGR, PTL

and delivery

Question 14

chronic htn increases risk for fetal

Answer 14

demise if uncontroleed

Question 15

dx of chronic htn

Answer 15

• Made prior to pregnancy or in first weeks of pregnancy
• Discussion about pregnancy and HTN should ideally be
done at preconception visit

Question 16

Management of Chronic HTN - Lifestyle

Answer 16

• Diet (particularly salt intake)

* Alcohol and smoking

Question 17

Management of Chronic HTN - medicaitons

Answer 17

• Methyldopa
• Labetalol
• Thiazide diuretic
• Nifedipine

Question 18

chronic htn testing

Answer 18

• 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

Question 19

you should do what as an NP

Answer 19

Consult/Collaborate for HTN cases
• Severe HTN should be managed by MD colleague
• Consult
• Collaborate
• Refer/Transfer

Question 20

bottom line

Answer 20

• Consult
• Collaborate
• Transfer
• Look at the entire clinical picture to make decisions and
always consult on HTN cases!