Hypertension in Pregnancy

Question 1

What should women who are at high risk of developing pre-eclampsia take?

Answer 1

Aspirin 75mg OD

Question 2

Which patients should be labeled as “high risk” of developing pre-eclampsia?

Answer 2

1. Type 1 or 2 diabetes mellitus
2. Autoimmune disorders such as SLE or antiphospholipid syndrome.
3. CKD
4. Hypertensive disease during previous pregnancies.

Question 3

When should they start and then stop taking aspirin?

Answer 3

From 12 weeks of pregnancy to term.

Question 4

What is hypertension in pregnancy usually defined as?

Answer 4

Systolic >140mmHg or diastolic > 90 mmHg

Or

An increase above booking readings of >30mmHg systolic or >15 mmHg diastolic

Question 5

What is the usual trend for blood pressure in pregnancy?

Answer 5

It usually falls during the first 20-24 weeks.

Then it rises back to pre-pregnancy levels in the latter part of the pregnancy.

Question 6

If a pregnant patient is hypertensive, what 3 categories should they fall into>?

Answer 6

1. Pre-existing hypertension
   
   • A history of HTN before pregnancy or <20 weeks.
   • No proteinuria or oedema.
   • Occurs in 5% of women and is more common in older women.
2. Pregnancy-induced hypertension (PIH) a.k.a. Gestational Hypertension
   
   • Hypertension in the second half of pregnancy. (>20 weeks)
   • No proteinuria or oedema.
   • Occurs in 5-7% of pregnancies.
   • Resolves following birth (typically 1 month afterwards). Women with PIH are at increased risk of future pre-eclampsia or hypertension later in life.
3. Pre-eclampsia - PIH + proteinuria (>0.3g/24 hours)
   
   • Oedema may occur.
   • Occurs in 5% of pregnancies.