Hypertension in pregnancy

Question 1

Pre-pregnancy advise wrt hypertension

Answer 1

Women who take ACEi/RB/chlorothiazide:

• increased risk of cong. anomaly
• discuss other anti-htn if planning pregnancy
• stop before pregnant
• Low salt diet

Question 2

Aim for maternal BP prepregnancy in uncomplicated HTN

Answer 2

<150/100

Question 3

If chronic htn and pregnant

Answer 3

Foetal growth
amniotic fluid volume assessment
UA doppler
All at 28,32,36wk

Question 4

Timing of birth in chronic htn

Answer 4

if <150/110 NOT offer before 37wks
Offer birth to women with refractory severe chronic htn after CS if required
Monitor BP after birth consider changing med

Question 5

Assessment of proteinuria in chronic htn during pregnancy

Answer 5

Protein:creatinine ratio

If 1+ or more obtained use spot urinry protein:creatinine or 24hr collection

Significant: P:C >30mg/mol or validated 24hr shows >300mg protein

Question 6

PACES counselling of chronic htn

Answer 6

Risks: pre-eclampsia, PTD, compliations
Change from ACEi/ARB -> labetalol
USS/FG/AFV at 28,32,36w
repeated if indicated
 BP monitoring
Explain maybe early delivery if uncontrolled HTN

Question 7

Gestational HTN

Answer 7

Mild: 140/90 to 149/99
Moderate: 150/100 to 159/109
Severe: 160/100 or higher

Question 8

Admit to hospital for gestational HTN

Answer 8

mild: no
Moderate: no
severe: yes (until BP<159/109)

Question 9

Treat Gestational HTN

Answer 9

Mild: no
Moderate: oral labetalol
Severe: otal labetalol
(aim <150/80-100 in both)

Question 10

Measure BP in GHTN

Answer 10

Mild: <1/wk
Mod: 2/wk
Sev: >4/d

Question 11

Test for proteinuria GHTN

Answer 11

mild: every visit UP:C
Mod: each visit UP:C
Sev: daily UP:C

Question 12

Blood test in GHTN

Answer 12

Mild: only routine
Mod: Kidney function, electrolytes, FBC, LFT, bilirubin (no need for repeats if no proteinuria at subsequent visits)
Sev: At presentation and then weekly: kidney func., electrolytes, FBC, LFT, bili

Question 13

When to offer birth <37wks in GHTN

Answer 13

Only if BP >160/110

Question 14

Mild/moderate GHTN Mx

Answer 14

USS foetal growth, amniotic fluid volume ass., UA doppler at Dx
Repeat if indicated
15% will develop into pre-eclampsia

Question 15

Severe GHTN/Preeclampsia MX

Answer 15

CTG at diagnosis
- Repeat if:
  - RFM
  - PV bleed
  - abdo pn
  - Deterioration in maternal condition
Repeat CTG only if indicated if ALL fetal monitoring normal
If conservative Mx planned:
- USS FG and amniotic fluid volume assessment
- UA doppler velocimetry
repeat 2wkly

Question 16

Postnatal Ix, monitoring of GHTN

Answer 16

Women w/GHTN who have given birth, measure BP:

• daily for 2d
• Once between d3-5
• as indicated if changed anti-htn

Question 17

GHTN post natal Mx

Answer 17

Continue antenatal anti-htn Mx
Consider Reduce anti-htn if BP <140/90
Reduce anti-htn if <130/80
Written care plan
If still on anti-htn after 2wks of community care review meds

Question 18

Methyldopa postnatal

Answer 18

stop within 2 days

Question 19

When should htn in pregnancy diseases resolve?

Answer 19

6 weeks

Question 20

PACES counselling on (G)HTN

Answer 20

RF: HTN, kidney dx. DM, HTN in prev. preg., multiple preg.
Risks: pre-ec., complicated/early delivery
Rx: labetalol PO
Monitoring:
- mild: 1/wk, - mod 2/wk -sev: admission
USS (at Dx or 28,32,36)
Postnatal Mx (BP, medication, monitoring)