hypertension in pregnancy Flashcards
what advise is given to women who have HTN wanting to get pregnant
if they are taking ACE inhibitors or ARBs it can increase the risk of congenital abnormalities
same goes for thiazide or thiazide like diuretics
what should not be used to lower BP
nitric oxide donors
progesterone
diuretics
low molecular weight heparin.
magnesium folic acid antioxidants (vitamins C and E) fish oils or algal oils garlic.
which women at high risk of pre-eclampsia
- hypertensive disease during a previous pregnancy
- chronic kidney disease
- autoimmune disease such as systemic lupus erythematosus or antiphospholipid syndrome
- type 1 or type 2 diabetes
- chronic hypertension.
if women is at high risk of preclampsia what medication is given as precautionary and when
75-150 mg of aspirin1 daily from 12 weeks until the birth of the baby.
if they have one high risk factor
if they have more than one moderate risk factor
moderate risk of factors of pre-eclampsia
- first pregnancy
- age 40 years or older
- pregnancy interval of more than 10 years
- BMI of 35 kg/m2 or more at first visit
- family history of pre-eclampsia
multi-fetal pregnancy.
at what BP should one stop treatment
SBP <90
DBP <70
the woman has symptomatic hypotension.
target - 135/85mmHg
Mx for HTN in pregnant women
1ST LINE - LABETALOL
- oral or iV
SEs - bradycardia, confusion, depression, dry eye, heart failure
CI - bronchospasm
nifedipine
SEs - abdo pain, dizzy, flushing, headache, nausea, angioedema, gingivial hyperplasia
CI - diabetes, elderly, ischaemic pain
methyldopa - stop within 2 days of birth
SEs - abdo distension, amenorrhoea, angioedema
CI- depression, acute porphyria, phaeochromocytoma
also provide aspirin 75-150mg once daily from 12 weeks
what test can be done to rule out pre-eclampsia between 20 weeks and up to 35 weeks of pregnancy
PIGF placetnal growth factor
what lifestyle and diet advise can be given to the pregnant woman
weight management
exercise
healthy eating
lowering the amount of salt in their diet.
No of antenatal appointments if women has chronic HTN
weekly appointments if hypertension is poorly controlled
appointments every 2 to 4 weeks if hypertension is well-controlled.
what additional fetal monitoring is done in women with chronic HTN and when
ultrasound for fetal growth and amniotic fluid volume assessment, and umbilical artery doppler velocimetry at 28 weeks, 32 weeks and 36 weeks.
which women need additional fetal monitoring
- severe pre-eclampsia
- pre-eclampsia that resulted in birth before 34 weeks
- pre-eclampsia with a baby whose birth weight was less than the 10th centile
- intrauterine death
- placental abruption.
during labour when do you measure BP HTN women
hourly, in women with hypertension
every 15-30 minutes until blood pressure is less than 160/110 mmHg in women with severe hypertension.
when to measure BP after giving birth with HTN women
daily for the first 2 days after birth
at least once between day 3 and day 5 after birth
as clinically indicated if antihypertensive treatment is changed after birth.
what advise to give if women choses to breastfeed while taking antihypertensives
consider monitoring the blood pressure of babies, especially those born preterm, who have symptoms of low blood pressure for the first few weeks
when discharged home, advise women to monitor their babies for drowsiness, lethargy, pallor, cold peripheries or poor feeding.
