Hypertension and pregnancy

Question 1

Other than pre-eclampsia, what other kinds of hypertensive disorders can you get?

Answer 1

Chronic HTN predating pregnancy
Pregnancy induced HTN = gestational hypertension
Transient gestational hypertension

Question 2

Define gestational hypertension

Answer 2

HTN developed after 20 weeks of pregnancy, not associated with proteinuria

Question 3

How do you manage someone with gestational hypertension?

Answer 3

Medically:
First line - Labetalol
2nd line - Nifedipine
3rd line - Methyldopa

Advise diet and exercise

Question 4

How often do you follow up someone with gestational hypertension?

Answer 4

If mild HTN aka 140/90:
- weekly BP and urine dip
- weekly bloods + bilirubin

If moderate HTN aka 150/100:
- biweekly BP measurement
- biweekly urine dip
- weekly bloods for LFTs, U and E, FBC, bilirubin

If severe - admit

Question 5

What is our target BP measurement?

Answer 5

Below 135/85

Question 6

If someone has severe gestational HTN, what do you do?

Answer 6

Admit, measure BP every 15-30 mins until it has fallen to below 160/110
Daily protein to creatinine ratio
Weekly bloods
Aim for BP under 135/85

Question 7

In which scenario do you offer biweekly/once a fortnight appointments for BP and urine dip and bloods?

Answer 7

If someone has long standing HTN and it is well controlled.

Question 8

When do you offer additional molecular testing for pre-eclampsia for someone with gestational hypertension?

Answer 8

ONCE only
Between 20 and 34+6 weeks
You’re offered a SLFT-1PLGF (some lovers find tripping on PEAS like gluefuck

Question 9

What is SLFT-1?

Answer 9

An anti-angiogenic molecule which prevents vessel growth. It inhibits PLGF. Therefore high SLFT-1 and low PLGF is characteristic of pre-eclampsia. Esp if the ratio is over 85.

Question 10

What bloods must you measure?

Answer 10

FBC
U and E
LFT
Bilirubin

Question 11

How do you manage someone with chronic hypertension, who has fallen pregnant?

Answer 11

1. Labetalol/Nifedipine/Methyldopa
2. Antenatal care - weekly appt if uncontrolled, or once a fortnight/once a month if controlled
3. PLGF screening from week 20

Question 12

Postnatal review for both chronic HTN as well as gestational HTN

Answer 12

Daily BP for the first 2 days
One BP measurement between day 3 and 5
Switch to a different antihypertensive if

Question 13

If someone has chronic HTN and is on ARBs and ACEi and thiazide diuretics, which of these must you stop and why?

Answer 13

ARBs and ACEi must be stopped due to harm to baby in second/third trimester.

Question 14

When must methyldopa be stopped?

Answer 14

Within 2 days post delivery

Question 15

Gestational HTN and chronic hypertension - you should avoid birth before?

Answer 15

37 weeks