Hypertension in pregnancy

Question 1

What are the main types of hypertension that can be experienced in pregnancy?

Answer 1

• Chornic hypertension
• Pregnancy induced hypertension (Gestational)
• Pre-eclampsia/Eclampsia

Question 2

What is gestational hypertension defined as?

Answer 2

Hypertension in the second half of pregnancy (BP - 140/90) in the absence of proteinuria or other features of pre-eclampsia

Question 3

What are those with gestational hypertension at risk of developing?

Answer 3

Pre-eclampsia

Question 4

How would you assess hypertension in pregnancy?

Answer 4

Distinguish type

• BP
• Urinalysis

Question 5

What hypertensive medications are used in pregnancy?

Answer 5

• Labetalol
• Hydralazine
• Nifedipine
• Methyldopa

Question 6

What antihypertensive drugs should be changed if they are already hypertensive pre-pregnancy?

Answer 6

• ACEi/ARBs - causes birth defects and reduced foetal growth
• Diuretics - volume depletion and fetotoxic

Question 7

What blood pressure would you want to aim for in a pregnant woman with chronic hypertension?

Answer 7

<150/90 (or 140/90 if end organ damage)

Question 8

What antiplatelet medication should you give someone from conception until birth if they have chronic hypertension?

Answer 8

Low dose Aspirin

Question 9

What foetal factors would you want to assess during pregnancy in someone with chronic hypertension?

Answer 9

• Foetal growth
• Amniotic fluid volume
• Umbilical artery dopplers

Question 10

What medications would you use for inducing labour in someone with hypertension?

Answer 10

Oxytocin - no syntometreine

Question 11

What are those on methyldopa at risk of post-natally?

Answer 11

Post-natal depression

Question 12

What should be avoided as hypertensive treatment when a mother is breast-feeding?

Answer 12

Diuretics

Question 13

What increase in BP is diagnostic of pregnancy induced hypertension?

Answer 13

Increase in BP of 30/15 during pregnancy

Question 14

Classification of mild HTN

Answer 14

140-149/90-99

Monitor

BP weekly, urine, protein

Question 15

Classification moderate HTN

Answer 15

150-159/100-109

Start meds

BP 2x weekly

Question 16

Clasificaiton of severe HTH

Answer 16

>160/110

Admit to hospital

Question 17

Post delivery what normally happens with gestational diabetes?

Answer 17

Measure BP for first 2 days after birth

Continue on antihypertensives by decreasing or stopping if BP falling

Switch from methyldopa to alternative within 2 days of delivery

Question 18

What are maternal/foetus risks in hypertension in pregnancy?

Answer 18

• Maternal
  
  • Abruption placentae
  • Cerebrovascular accident
  • DIC
• Foetal
  
  • IUGR
  • Prematurity
  • Intrauterine death

Question 19

Who is recommended to take asprin?

Answer 19

Women at high risk of pre-eclampsia (75mg dailut from 12 weeks gestation)

• 1 of
  
  • Hypertension/pre-eclampsia in past pregnancies
  • CKD
  • Autoimmune disease (eg SLE)
  • DM 1 or 2
  • Chronic hypertension
• 2 of
  
  • >40 y/o
  • BMI >35 @ booking
  • Prev preg >10 years ago
  • FH pre-eclampsia
  • Multiple preg