Hypertension NICE

Question 1

High risk factors for pre-eclampsia? (should receive aspirin)

Answer 1

Previous HTN in pregnancy
CKD
SLE/APL
T1/T2 DM

Question 2

Moderate risk factors for pre-eclampsia. (2 or more = aspirin from 12w)

Answer 2

Nullip
>40
Pregnancy interval >10 years
BMI >35
FHx PET
Multiple pregnancy

Question 3

What PCR level is indicative of PET?

Answer 3

> 30mg/mmol

Question 4

What does PLGF-based testing assess?

Answer 4

Helps to diagnose pre-eclampsia, helpful in women with chronic hypertension.

Looks for reduced placental-growth factor levels which indicate placental dysfunction and increased risk of pre-term birth.

Used between 20-37 weeks

Question 5

What is an abnormal PLGF level?

Answer 5

<100 abnormal
<12 highly abnormal

Question 6

At what blood pressure should you offer pharmacological treatment?

Answer 6

> 140/90

Question 7

1st line treatment gestational hypertension?
2nd?
3rd?

Answer 7

Labetalol
Nifedipine
Methyldopa

Question 8

What prediction models can help guide decisions about care in PET?

Answer 8

fullPIERS or PREP-S
Use platelets, AST, creatinine, symptoms

Question 9

When should you admit to hospital for surveillance?

Answer 9

Systolic BP >160
Rise in Cr, Plt, ALT
Signs of severe pre-clampsia, fetal compromic, pulmonary oedema

Question 10

In women with HTN in pregnancy, when should you dip urine as an inpatient?

Answer 10

Daily in gestational HTN
Only repeat if clinically indicated in PET
(I guess you’re looking to see if PET has developed in your gest HTN patients)

Question 11

How should you monitor baby in PET?

Answer 11

USS at diagnosis and then 2 weekly

Question 12

What might trigger early delivery in PET patients?

Answer 12

Unable to control BP despite using 3 classes of anti-hypertensives
spO2 <90%
Deteriorating LFT, U&E, FBC
Neurological features
Placental abruption
Abnormal dopplers

Question 13

When should BP be measured in labour in women with HTN?

Answer 13

Hourly if HTN only
Every 15-30 mins if severe hypertension

Question 14

How to manage severe pre-eclampsia or eclampsia?

Answer 14

IV magnesium sulfate - if severe symptoms or birth planned within 24 hours.

Refer to ICU

labetalol, nifedipine, IV hydralazine to control BP

Do not use diazepam

Question 15

Post-natal antihypertensives?

Answer 15

Enalapril
Nifedipine or amlodipine in black women

Can add atenolol or labetalol if poor control

Question 16

Risk of recurrence of HTN disorder in future pregnancy?

Answer 16

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