Hypertension in Pregnancy (Management) Flashcards
When should the risk of pre-eclampsia be assessed?
At booking
If there is hypertension at < 20 weeks gestation, what should you do?
Look for an underlying cause
What medication is used to try and prevent pre-eclampsia in high risk women? If a women is deemed to be high risk for pre-eclampsia, when should this be given?
Daily 75mg low dose aspirin, started by 12 weeks
What is the function of aspirin?
Inhibit the cyclo-oxygenase enzyme which prevents TXA2 synthesis (a vasoconstrictor which is produced by platelets)
What are some factors deemed high risk by NICE that would indicate use of low dose aspirin?
Previous hypertension in pregnancy or chronic hypertension, diabetes, autoimmune disease, CKD
Where are chronic hypertension and mild-moderate gestational hypertension managed? Describe what is done?
In the community, BP is monitored as clinically indicated and proteinuria checked for at every antenatal appointment - if this develops then blood tests are repeated
In cases of chronic pre-existing hypertension, when should ultrasound scans be used to monitor foetal growth and AFI?
28 and 32 weeks
In cases of gestational pregnancy induced hypertension, when should ultrasound scans be used to monitor foetal growth and AFI?
At the time of diagnosis if < 34 weeks
A MAP of over 150mmHg implies a significant risk of what?
Intracerebral haemorrhage
BP in pregnancy is usually treated if over what value? A BP of over what requires immediate drug treatment?
150/100 / 170/110
In pregnancy, you should be aiming for a blood pressure of what?
140-150/90-100mmHg
What are some anti-hypertensives which are contraindicated in pregnancy?
Diuretics and ACE inhibitors
What is the first line medication for hypertension in pregnancy? What is the mechanism of this drug?
Labetalol - alpha and beat adrenoceptor antagonist
What is the second line PO medication for hypertension? What is the mechanism of this drug?
Nifidipine - Ca++ blocker
What is the second line IV medication for hypertension? What is the mechanism of this drug?
Hydralazine - vasodilator
What is the contraindication to the use of labetalol in pregnancy?
Asthma
What are the contraindications to the use of methyldopa in pregnancy?
Depression, and the postnatal period
What are all the drugs which can be used to manage hypertension in pregnancy?
Methyldopa, labetalol, nifidipine, hydralazine, doxazocin
Which drug used to treat hypertension in pregnancy is not safe in breastfeeding?
Doxazocin
What drug is given to stop and prevent seizures in eclampsia?
Magnesium sulphate
What is the loading dose of magnesium sulphate?
4g IV over 5 mins
What is the maintenance dose of magnesium sulphate?
1g/hour IV infusion
If there are further eclamptic seizures following the first one, what is the management?
2g magnesium sulphate
If seizures are persistent, what is the management?
10mg diazepam IV
Does oliguria in pregnancy require intervention? If you have any doubts about a patients renal function, what should you do?
No / measure urine osmolality
Fluid challenges in severe pre-eclampsia and eclampsia are dangerous - what should be done instead?
Run a patient dry - 80mls/hour
What is the only definitive management of eclampsia?
Delivery
If a woman is an inpatient as a result of hypertensive problems in pregnancy, how often should each of the following be done: a) BP? b) urinalysis? c) blood tests?
a) 4 hourly b) daily c) minimum twice weekly
If there is proteinuria on urinalysis, what is the next best investigation?
Urine PCR
Foetal growth and AFI are determined by US at diagnosis of pre-eclampsia, how often should they be repeated after this?
Every 2-4 weeks
How often is cardiotocography done in women with pre-eclampsia?
Daily
Ultrasound scans of mothers with pre-eclampsia are used to assess what?
Foetal growth, amniotic fluid index and umbilical artery Doppler
If a woman with eclampsia is going to deliver her baby early - what is the most important thing to give?
2 doses of 12mg dexamethasone
Most women with pre-eclampsia deliver within how long of diagnosis?
2 weeks
For women with hypertension in pregnancy a delivery should be aimed for when?
37 weeks
What are some indications for delivery in a woman with pre-eclampsia?
Term gestation, inability to control BP, rapidly deteriorating blood tests, eclampsia and other crises, foetal compromise
What is the advantage to giving mothers with hypertension an epidural during labour?
It causes vasodilation which decreases BP
What medication should be avoided at delivery in women with hypertension?
Ergometrine
