Pre-existing Hypertension In Pregnancy Flashcards
Why is pre-existing hypertension in pregnancy important?
It’s a major cause of maternal, fetal, and neonatal morbidity and mortality
What complications are women with pre-existing hypertension in pregnancy at increased risk of?
- Abruptio placentae
- Cerebrovascular accident
- Disseminated intravascular coagulation
What complications are the fetus of a woman with pre-existing hypertension in pregnancy at risk of?
- IUGR
- Prematurity
- Intrauterine death
What is defined as pre-existing hypertension either at booking or pre-conception?
≥ 140/90mmHg
What should be the aim of managing pre-existing hypertension in pregnancy?
- <150/100mmHg
- <140/90mmHg if there is already end organ damage
What does the management of pre-existing hypertension in pregnancy depend on?
- Woman’s BP
- Gestational age
- BLood flow to placenta
What is the main recommended type of management for women with pre-existing hypertension in pregnancy where there is not other associated risk factors to mother or fetus?
Non-pharmacological management
What are the non pharmacological options for managing pre-existing hypertension in pregnancy?
- Close supervision
- Limitation of activities
- Bed rest in left lateral position
In women with pre-existing hypertension in pregnancy that is medicated what should be done?
Review the medication and inform the patient of the risks involved with them
Which anti-Hypertension agents should be stopped as soon as possible in pregnancy (or even before if planning)?
- ACE inhibitors
- Angiotensin II antagonists
Why should ACEi and angiotensin II antagonists be stopped as soon as possible in pregnancy?
They cause an increased risk of fetal abnormality
What drugs can be used for hypertension in pregnancy?
- Labetalol
- Nifedipine
- Methyldopa
- Enalapril
- Hydralazine
What is the first line (and only licensed drug) for hypertension in pregnancy?
Labetalol
What type of drug is Labetalol ?
Beta blocker
When is labetalol contra-indicated?
- Asthma
- Type 1 diabetes
- Pheochromocytoma
- Black, Afro Caribbean women
Why is Labetalol contra indicated in asthma?
- Can cause bronchospasm
- Can make less responsive to inhalers
Why is labetalol contra-indicated in type 1 diabetes?
Reduces awareness of hypoglycaemia
Why is labetalol contra-indicated in black, afro-caribbean women?
It is not effective
What are the side-effects of labetalol?
- Scalp tingling
- Headache
- Weakness
- Liver damage
- GI disturbance
What sort of drug is nifedipine?
Calcium channel blocker
What sort of release nifedipine should be given in pregnancy?
Modified release
What are the two brands of nifedipine used in pregnancy?
- Adipine MR
- Adalat LA
How long does adipine MR last?
12 hours
How often should adipine be administered?
BD or as a stat dose
