HYPERTENSION IN PREGNANCY

Question 1

What are the three forms of hypertension in pregnancy?

Answer 1

1. Chronic - before pregannacy or hypertension could be diagnosed in the first 20 weeks of pregnancy
2. Gestational hypertension - new hypertension after 20 weeks
3. Pre-eclampsia - new hypertension after 20 weeks with significant proteinuria or other organ dysfunction

Question 2

If a woman with
chronic hypertension becomes pregnant and is taking ACE-I/ARB, what should a clinician do?

Answer 2

• Stop ACE-I/ARB if they become pregnant
• Preferably within 2 days
• Offer alternative (e.g. labetolol)

Question 3

Can women take Thiazide or Thiazide-like diuretics for the treatment of chronic hypertension during pregnancy?

Answer 3

NO!
- increased risk of congenital abnormalities and neonatal complications
- If planning pregnancy or pregnant, need to be given alternative

Question 4

When would you offer antihypertensives to pregnant women?

Answer 4

if they are not on treatment already and have sustained BP of either:
- Systolic BP > 140 mmHg
OR
- Diastolic BP > 90 mmHg

Question 5

Which antihypertensive do you offer to pregnant women ?

Answer 5

1. Labetalol
2. MR Nifedipine (unlicensed)/ Methyldopa (unlicensed)

Question 6

What is the target blood pressure whilst on anti-hypertensives for pregnant women?

Answer 6

less than 135/85?mmHg

Question 7

What is the target blood pressure for women with chronic hypertension after giving birth?

Answer 7

lower than 140/90 mmHg

Question 8

If women were managed with methyldopa, how long can they continue it after birth?

Answer 8

• STOP
• restart original antihypertensive within 2 days of birth
• Due to risk of post-natal depression

Question 9

How do we assess for proteinuria in Hypertensive disorders in pregnancy? And Why?

Answer 9

• automated reagent-strip reading device, dipstick screening for proteinuria
• Then use a spot urinary protein: creatinine ratio to quantify how significant proteinuria is
• If significant proteinuria present, then likely to be preeclampsia

Question 10

What are the symptoms of pre-eclampsia?

Answer 10

• Severe headache
• Problems with vision (e.g. blurring or flashing before the eyes)
• Severe pain just below the ribs
• Vomiting
• Sudden swelling of the face, hands or feet

Question 11

In women with preeclampsia where early birth is likely, what can be administered to them to help fetal lung maturation?

Answer 11

• Antenatal Corticosteroids
  e.g. Dexamethasone,
  Betamethasone

Question 12

Should patients with chronic hypertension in pregnancy take Aspirin?

Answer 12

• Yes
• Chronic hypertension put pregnant women at HIGH RISK of pre-eclampsia
• They should take 75-150mg daily from 12 weeks of gestation up until birth