Hypertension in Pregnancy

Question 1

Normal pregnancy is characterized by?

Answer 1

Increase in CO, reduction in SVR & minimal change in mean BP. These changes are associated with a 10 - 15 bpm increase in HR.

Question 2

Normal BP in pregnancy

Answer 2

<140/90 mmHg

Question 3

High BP in pregnancy

Answer 3

> or equal to 140/90 mmHg on 2 occasions at least 4hrs apart.

Question 4

4 types of hypertension in pregnancy

Answer 4

1. Gestational hypertension
2. Preeclampsia/eclampsia
3. Chronic hypertension
4. Preeclampsia superimposed on chronic hypertension

Question 5

Define Gestational Hypertension

Answer 5

• > or equal to 140/90 mmHg BP on at least 2 occasions 4 hrs apart after 20wks of gestation in a previously normotensive woman.
• no proteinuria
• no end-organ features
• BP returns to normal 12wks postpartum

Question 6

Preeclampsia

Answer 6

• > or equal to 140/90 mmHg BP on at least 2 occasions at least 4hrs apart after 20wks of gestation in a previously normotensive woman.
• proteinuria = +1, protein:creatinine ratio >30 mg/mmol, albumin:creatinine >8 mg/mmol.
• end-organ features (e.g. thrombocytopenia <100,000 microL).

Question 7

Examples of end-organ features in Preeclampsia

Answer 7

• thrombocytopenia = <100,000 microL
• renal insufficiency = increase serum creatinine >1.1 mg/dL or a doubling of the serum creatinine conc. in the absence of other renal dxs.
• impaired liver function = increase liver transaminase levels.
• pulmonary edema
• persistent cerebral or visual symptoms

Question 8

Clinical features for end-organ changes

Answer 8

Headache, blurring of vision, severe epigastric pain & cough or SOB.

Question 9

Name some clinical factors that have been associated with an increased risk of developing Preeclampsia.

Answer 9

• Nulliparity
• Preeclampsia in a previous pregnancy
• Age >40 yrs or <18 yrs old
• Family history of preeclampsia
• Chronic hypertension
• Chronic renal dxs
• Autoimmune dxs
• Obesity

Question 10

Severe Preeclampsia

Answer 10

• BP >160/110 mmHg
• Proteinuria = +1 dipstick, > or equal to 8 mg/mmol, urine protein: creatinine ratio > or equal to 0.3.
• Any end-organ changes

Question 11

Target BP when managing high BP in pregnancy

Answer 11

135/85 mmHg or less

Question 12

Chronic Hypertension

Answer 12

• High BP before 20wks in pregnancy
• Known hypertension prior
• BP doesn’t normalize after 12wks postpartum

Question 13

Preeclampsia superimposed on chronic hypertension

Answer 13

• worsening of baseline hypertension
• new onset of worsening proteinuria
• new onset or worsening end-organ changes

Question 14

HELLP syndrome stands for?

Answer 14

Hemolysis
Elevated
Liver enzymes
Low
Platelets