Hypertension in Pregnancy

Question 1

Definition of HTN in pregnancy

Answer 1

• Blood pressure >140/90 on two occasions > 4 hours apart
• <20 w = chronic HTN
• > 20 weeks w/out proteinuria = gestational htn
• > 20 weeks w/proteinuria = pre-eclamsia (+/- severe features)

Question 2

Chronic HTN in pregnancy definition

Answer 2

-Use of antihypertensive medication prior to Preg, OR
-onset of HTN before Preg, prior to 20 w gest OR
-HTN that persists beyond 12 w
postpartum

Question 3

Mild vs. Sev Chronic HTN in pregnancy

Answer 3

• mild: 140-159/90-109

- severe: >160/>110

Question 4

Mild Pre-E definition

Answer 4

• > 140/90 x2 after 20w

- 300mg prot/24h OR 1+ q6h OR P:C>0.3

Question 5

Severe Pre-E definition

Answer 5

• > 160/110 x2 after 20w
• 300mg prot/24h OR 1+ q6h OR P:C>0.3
• SF: oliguria (<500cc/24h), cerebral/visual disturbance, pulm edema/cyanosis, epigastric/RUQ pain, thrombocytopenia (<100,000), Cr>1.1, LFTsx2ULN

Question 6

D/o associated w/HTN in pregnancy

Answer 6

• CHTN + PEC
• Eclampsia
• HELLP (Hemolysis, El. Liver enzymes, Low Platelets) = severe Pre-E variant
• AFLP = acute fatty liver of pregnancy (severe LFTs, low glucose)