Hypertension

Question 1

How does BP change in pregnancy?

Answer 1

BP falls in first trimester pregnancy due to a fall in vascular resistance
Stroke volume the increases after this time, leading to a risk in BP
Tends to fall again after delivery peaking again at day 3-4 postpartum

Question 2

What is hypertension in pregnancy defined as?

Answer 2

> 140
90

on 2 separate occasions, 6h apart

Increase in booking readings of >30 systolic or >15 diastolic

Question 3

How do you categoriese women with hypertension in pregnancy?

Answer 3

Chronic pre-existing HTN:
- Elevated blood pressure > 140/90 before 20 weeks gestation

Pregnancy induced HTN
- hypertension occurring in second half of pregnancy (after 20 weeks)

Pre-eclampsia
- PIH associated with proteinuria (>0.3g/24h)

Question 4

How should you manage women with pre-existing hypertension?

Answer 4

ACEi, ARB, Thiazides risk congenital abnormality

Pre-conception change to labetalol or metxhyldopa

Aim for BP <150/90 (<140/90 if end organ damage) but with diastolic >80

Give aspirin 75mg/24h to prevent pre-eclampsia for conception to delivery

Question 5

When should you admit?

Answer 5

> 160/110

Question 6

What intrapartum management for chronic hypertension?

Answer 6

Monitor BP hourly if <159/109, continuously if >160/110

Advise operative delivery if HTN is not responding

Give oxytocin alone at third stage (not ergometrine - causes severe HTN)

Question 7

What is pregnancy induced HTN?

Answer 7

HTN in second half of pregnancy >140/90 in the absence of proteinuria or other features of pre-eclampsia

Question 8

What is management of PIH?

Answer 8

Urine testing for proteinuria or urine PCR
Check urine and BP weekly if mild but start treatment with labetalol if >150/100

If BP>160/110 admit to hospital
Check FBC, U&E, LFT and bilirubin
If cannot destabilise make plans for delivery

Question 9

What management of PIH in labour?

Answer 9

During labour continue antihypertensives
Monitor BP continuously if >160/110 or hourly otherwise
If BP outside target range despite antihypertensive advise operative delivery

Question 10

What is postnatal care for PIH?

Answer 10

Continue antenatal antihypertensives, r educing treatment if < 130/80
Review at 2 and 6 weeks

Question 11

What consideration in 3rd stage of labour in HTN?

Answer 11

IF active management of 3rd stage:
Do not give ergometrine
Oxytocin alone is administered