Hypertensive disorders in Pregnancy Flashcards
Define chronic HTN
Preexisting HTN or new onset HTN without proteinuria, before 20 weeks gestation
Define gestational HTN
New onset HTN without proteinuria after 20 weeks of gestation
Define preeclampsia
New onset of HTN after 20 weeks of gestation plus new onset of the following:
- Proteinuria
-Signs of end organ dysfunction
- Uteroplacental dysfunction
Define chronic HTN with superimposed preeclampsia
New onset proteinuria in a woman with chronic HTN but no proteinuria, before 20 weeks gestation
A patient is admitted to the hospital due to suspicion of preeclampsia, how can I check for proteinuria in the patient?
24H Urinary protein
Dipstick protein
Urine creatinine ratio
What are some signs of end-organ damage?
Platelet count < 100
LFT > 2x ULN
Doubling of SCr in absence of other renal diseases
Pulmonary edema
Neurological complications
How can I prevent preeclampsia with pharmacological intervention? What are the indications for treatment?
Low dose of aspirin at 100mg or more daily
Given to high risk patients
- HTN on previous pregnancy
-Multifetal gestation
- Autoimmune disease
- DM
-CKD
When should aspirin be started?
After 12 weeks but ideally before 16 weeks and to continue after delivery
What are the first line options for HTN in pregnancy?
Labetalol: Lesser adverse effects on uroplacental blood flow and fetal growth
Nifidepine ER: Most studied and widely used CCB
Why is hydrochlorothiazide considered 2nd or 3rd line therapy?
Causes potential interference with normal blood volume expansion during pregnancy (thiazide attempts to decrease blood volume; while pregnancy increases)
What are two agents falling out of favour for use in HTN disorders?
Methyldopa due to increased adverse effects
Hydalazine due to mimicking of symptoms associated with severe preeclampsia and imminent eclampsia
What is the BP threshold to initiate treatment?
SBP 140; DBP 90
