Hypertension disorders of pregnancy

Question 1

Definition of HTN and severe HTN in pregnancy

Answer 1

HTN: Either SBP >140mmHg or DBP >90mmHg based upon >1 measurement that are at least 4 hours apart
Severe HTN: After 2 measurement of SBP >160mmHg and/or DBP >110mmHg

Question 2

What are the 4 categories of HTN in pregnancy?

Answer 2

1. Chronic HTN (before 20 weeks gestation)
2. Gestational hypertension (new onset HTN after 20 weeks gestation; no proteinuria)
3. Preeclampsia (new onset HTN after 20 weeks gestation + proteinuria or signs of end-organ dysfunction or uteroplacental dysfunction)
4. Chronic HTN superimposed with preeclampsia (new onset proteinuria in women with chronic HTN before 20 weeks gestation)

Question 3

What are the parameters used to measure proteinuria?

Answer 3

1. 24h urinary protein (UTP)
2. Dipstick protein
3. Urine protein : Creatinine ratio (uPCR)

Question 4

What are the parameters used to measure signs of end-organ damage?

Answer 4

1. Platelet count
2. LFT
3. SCr
4. Pulmonary edema
5. Neurological complications

Question 5

What symptom is eclampsia known for?

Answer 5

Seizures

Question 6

What is the agent used for prevention of preeclampsia?

Answer 6

Low dose aspirin 100mg daily

Question 7

When is aspirin recommended for prevention of preeclampsia?

Answer 7

1. HTN on previous pregnancy
2. Multifetal gestation
3. Autoimmune diseases
4. DM
5. CKD

Question 8

When should low dose aspirin be started?

Answer 8

After 12 weeks and ideally before 16 weeks
- Continue until delivery

Question 9

Treatment options for HTN in pregnancy

Answer 9

1. Methyldopa
2. Labetalol
3. Nifedipine ER
4. HCTZ (2nd/3rd line)
5. Hydralazine (not recommended)

Question 10

At what BP threshold should we initiate treatment for HTN in pregnancy?

Answer 10

140/90 mmHg