Hypertension in Pregnancy

Question 1

What is the definition of resistant HTN in pregnancy?

Answer 1

Resistant HTN is the need for 3 antihypertensives for BP control at >/= 20 weeks.

Question 2

What is the definition of gestational HTN?

Answer 2

Gestational HTN develops >/=20 weeks for the first time.

Question 3

What is the definition of pre-existing (chronic) HTN?

Answer 3

Chronic HTN is present before 20 weeks/present before pregnancy.

Question 4

Proteinuria is defined as ___ in pregnancy.
A. >/= 30 g/mmol on a random urine sample
B. >/= 300 mg/day on 24 urine collection
C. Creatinine = 150
D. Creatinine = 300

Answer 4

B. >/= 300 mg/day on 24 urine collection OR >/= 30 mg/mmol urinary creatinine on a random urine sample.

Question 5

True or false. ACEi and ARBs are safe in pregnancy.

Answer 5

FALSE

Question 6

What are the antihypertensive options for severe HTN in pregnancy?

Answer 6

Labetalol 20mgIV q20-30min
Hydralazine 5mg IV q20-30min
Nifedipine 5-10mg PO q 30min

Question 7

What is the definition of preeclampsia?

Answer 7

Preeclampsia may arise de novo. It is defined as gestational hypertension with one or more of the following: new proteinuria or one or more adverse conditions or one or more severe complications. Severe preeclampsia is defined as preeclampsia with one or more severe complications.

Question 8

A 38 yo G1P0 presents with severe headache. She is currently 35+1. BP is 167/100, RR 16. You make a diagnosis of preeclampsia. A 4g loading does of magnesium sulphate is given and preparation for delivery begins. You notice that her RR drops to 7. What is the possible cause of her hypoventilation? What is the treatment?

Answer 8

Magnesium toxicity results in respiratory depression, decreased urine output and hyporeflexia. The treatment is 10% calcium gluconate 10mL IV.

Question 9

A 33 year old G2P1 woman presents to triage at 35 weeks gestation. BP 150/95. Previous pregnancy resulted in a spontaneous vaginal delivery at 39 weeks three years ago with a different partner. Her father has HTN. You are sending off labs when you are called to her room. She complains of new onset headache, and scotoma. She denies epigastric pain or abdominal pain, has good fetal movement and the exam is normal, except that her reflexes are brisk at 3+. What is the likely diagnosis and management of this patient?

Answer 9

This patient is hypertensive and has greater than 1 adverse complication resulting in a diagnosis of preeclampsia. The cure for preeclampsia is delivery. MgSO4 is also indicated.

Question 10

What is the criteria for HTN vs. severe HTN?

Answer 10

HTN = SBP >/=140 and/or DBP >/= 90
Severe HTN = SBP >/=160 and/or DBP >/=110

HTN and severe HTN diagnosis must be based on two measurements take in the same arm >/= 15 min apart.