Hypertension in pregnancy and pre-eclampsia

Question 1

What is hypertension in pregnancy?

Answer 1

> =140/90

Question 2

What is pregnancy induced hypertension?

Answer 2

new hypertension > 20 weeks, no proteinuria

Question 3

What is pre-eclampsia?

Answer 3

multisystem disorder characterised by hypertension >20 weeks AND proteinuria (PCR >30 or >=300mg protein/24hrs)

Question 4

What is eclampsia?

Answer 4

complication of pre-eclampsia - seizure/convulsive episode

Question 5

What is severe hypertension in pregnancy?

Answer 5

> =160/>=100

Question 6

What are high risk factors for pre-eclampsia?

Answer 6

Hypertension in previous pregnancy
Chronic renal or Autoimmune disease
Diabetes
Chronic hypertension

Question 7

What are low-risk factors for pre-eclampsia?

Answer 7

first pregnancy
age more than 40 years
BMI >35
family history of pre-eclampsia
multiple pregnancy

Question 8

What medications hypertensive should be reviewed in pregnancy?

Answer 8

ACEI, ARB, diuretics, statins (stop)

Labetalol, nifedipine, methyldopa (antihypertensives used in pregnancy)

Aspirin 150mgs 12 weeks – 36 weeks / birth

Folate 400µg - start before pregnancy

Question 9

What are maternal complications of hypertension?

Answer 9

Intracranial hemorrhage (HELLP)
Acute fatty liver of pregnancy
Eclamptic seizures
Pulmonary edema
(hepatic necrosis, hepatic rupture)

Question 10

What are fetal complications of hypertension?

Answer 10

Fetal growth restriction
Still birth (placental insufficiency)
Prematurity

Question 11

What are symptoms of hypertension in pregnancy?

Answer 11

Headache
Visual disturbances
Nausea
Abdominal pain
Feeling unwell
Reduced fetal movement

Question 12

What are investigations for hypertension in pregnancy?

Answer 12

BP monitoring

Urinalysis for proteinuria, Protein Creatinine ratio (30mg/mmol)

Blood tests – FBC, liver function tests, urea and electrolytes (coagulation profile)

Fetal assessment – CTG, Ultrasound

Question 13

What are drugs to control hypertension in pregnancy?

Answer 13

Labetalol oral / IV
Nifedipine oral
Hydralazine IV

Question 14

What is the treatment for prevention of eclampsia?

Answer 14

Magnesium sulphate - used for fetal / neonatal neuroprotection in preterm birth

4 gram iv bolus then 1g/hr infusion

Question 15

What is PLGF?

Answer 15

Placental Growth Factor to diagnose suspected pre-eclampsia in women who present with hypertension (20 – 35wks)

Question 16

What is HELLP and placental abruption?

Answer 16

Haemolysis, elevated liver enzymes, low platelets

Rare complication of hypertension especially pre-eclampsia

Question 17

When should delivery occur according to HELLP?

Answer 17

Deliver if
platelets less than 75 ish or ALT rising ++ >80
Fetal concerns

Question 18

What is the management of postnatal hypertension?

Answer 18

Often needs continued treatment

Risk of eclampsia continues for a few days

ACEi if likely treatment > 4 weeks

Exclude persistent proteinuria (ie renal disease)