Pregnancy Induced Hypertension

Question 1

What is pregnancy induced hypertension?

Answer 1

New onset hypertension

After 20 weeks of gestation

Without significant proteinuria or symptoms and signs of PET

Where hypertension resolved within 6 weeks postpartum

Question 2

What are the complications of PIH?

Answer 2

Maternal and fetal

Maternal
PET
Imminent eclampsia 
Eclampsia 
Placental abruption
Hypertension complications 

Fetal
PTB
LBW
PNM

Question 3

What is the classification of PIH?

Answer 3

Mild <150/100

Moderate <160/110

Severe >= 160/110

Question 4

What are the safe anti hypertensives in pregnancy?

Answer 4

Labetalol
Methyldopa
Nifedipine
Hydralazine

ACEi ARB atenolol are teratogenic
Do not use NO, diuretics, progesterone, salt restriction, antioxidants, garlic

Question 5

How would you manage PIH?

Answer 5

Severe (Emergency)

General and specific management

GENERAL
Always exclude PET by Hx, Ex, Ix
Evaluate risk factors for developing PET
Prophylactic Aspirin 75 mg od PO nocte

SPECIFIC
#Mild PIH
No need to treat
Outpatient monitoring weekly
Twice weekly if multiple/ high risk of PET
If <34/40, USS growth, AFV, UtAD for FGR
CTG if fetal activity abnormal

#Moderate PIH
Labetalol 100 mg bd PO (target <150/100)
Twice weekly monitoring for PET &amp; HELLP 
(BP, UP, FBC, LFT, RFT)
USS and CTG same as mild PIH

Inpatient care until BP <160/110
IV labetalol 1 mg/min (titration per 30 mins)
Switch to oral after <150/100
Offer birth for refractory PIH after steroids
BP qds
UP daily
FBC LFT RFT on admission and weekly
USS admission and 2 weekly
CTG on admission, repeat if indicated, then weekly monitoring
Evaluate for timing of birth

Question 6

When would you deliver a PIH mother?

Answer 6

If BP <160/110 with or without medicine, don’t induce.
Offer birth after 37/40

If refractory severe hypertension, give course of corticosteroids and offer birth.

Question 7

What are the contraindications and cautions for labetalol?

Answer 7

Contraindications 
Bronchial asthma 
Heart block 2nd or 3rd degree
Metabolic acidosis
Hepatic impairment

Cautions
Check and monitor LFT and RFT

Question 8

What are the special precautions for hypertensive mothers in Labour?

Answer 8

mild/moderate

Hourly BP
Continue antenatal antihypertensives
Don’t limit 2nd stage if stable BP.

Continuous NIBP
Continue antenatal antihypertensives
If BP unstable with treatment offer OVD in 2nd stage of Labour.

Question 9

What are the special postnatal managements in hypertensive mothers?

Answer 9

Monitor BP
Daily for 2 days.
Again in 3-5 days

Change methyldopa to a beta blocker within 2 days to avoid depression

Continue antenatal antihypertensives until BP <140/90

Don’t give diuretics if breastfeeding

Assess adequacy of breastfeeding daily for 2 days.

Question 10

How would you follow up a PIH mother postnatally?

Answer 10

Write a care plan on discharge
With where to follow up
Who to follow up
Monitoring frequency 
Thresholds for stopping drugs
Indications for referral

If drugs are to be continued, review in 2 weeks and at 6 weeks.