Gestational Hypertension

Question 1

What is gestational hypertension?

Answer 1

Development of new hypertension in a pregnant woman after 20 weeks gestation

Question 2

What features are NOT present in gestational hypertension?

Answer 2

• Proteinurea

- Other signs of pre-eclampsia

Question 3

What is the definition of high blood pressure in pregnancy?

Answer 3

> 140/90 mmHg on two or more separate occasions at least 6 hours apart

Question 4

What are the maternal risk factors for gestational hypertension?

Answer 4

• Obesity
• <20 or >40 years old
• DM
• Previous gestational hypertension
• Renal disease
• Thrombophilia
• Having donated a kidney

Question 5

What pregnancy factors increase risk of gestational hypertension?

Answer 5

• Multiple gestation

- Placental abnormalities

Question 6

What placental abnormalities increase risk of gestational hypertension?

Answer 6

• Hyperplacentosis

- Placental ischaemia

Question 7

What is hyperplacentosis?

Answer 7

Excessive exposure to chorionic villi

Question 8

What genetic factors predispose to gestational hypertension?

Answer 8

• Family history of pre-eclampsia

- Black or hispanic

Question 9

What is the presenting feature of gestational hypertension?

Answer 9

High blood pressure

Question 10

What symptoms must be absent to suggest gestational hypertension?

Answer 10

Symptoms of pre-eclampsia

Question 11

What are some symptoms of pre-eclampsia that should not be present in gestational hypertension?

Answer 11

• Significant weight gain
• Peripheral oedema
• Headaches
• Upper abdominal pain

Question 12

What are the three classifications of gestational hypertension?

Answer 12

• Mild
• Moderate
• Severe

Question 13

What is mild gestational hypertension?

Answer 13

140-149/90-99 mmHg

Question 14

What is moderate gestational hypertension?

Answer 14

150-159/100-109 mmHg

Question 15

What is severe gestational hypertension?

Answer 15

> 160/110 mmHg

Question 16

Other than BP measurement, what other investigations could be performed for gestational hypertension?

Answer 16

• Urine testing
• Assessment of oedema
• Frequent weight measurements
• Liver and kidney function tests
• Coagulation screen

Question 17

What does management of gestational hypertension depend on?

Answer 17

Severity

Question 18

What is the management for mild gestational hypertension?

Answer 18

• BP measure 2x weekly before 32 weeks or at risk of pre-eclampsia and once otherwise
• Check urine for protein at each visit

Question 19

What is the management for moderate gestational hypertension?

Answer 19

• Monitor BP 2x weekly
• Start labetalol to keep BP <150/80-100
• Dip urine at each visit
• Arrange blood tests

Question 20

What blood tests should be performed for moderate gestational hypertension?

Answer 20

• FBC
• Electrolytes
• Renal function
• LFTs

Question 21

What is the initial management for severe gestational hypertension?

Answer 21

• Admit to hospital

Question 22

What treatment should be given for severe gestational hypertension in hospital?

Answer 22

• Same as moderate
• Monitor BP 4x daily
• Dip urine daily
• Weekly blood tests

Question 23

What monitoring should patients have for severe gestational hypertension after discharge?

Answer 23

Check BP and urine 2x weekly

Question 24

What checks for fetal wellbeing should be made in mild/moderate gestational hypertension?

Answer 24

USS at 34 weeks to assess growth and amniotic fluid volume

Question 25

What checks for fetal wellbeing should be made in severe gestational hypertension?

Answer 25

CTG at diagnosis and USS and umbilical artery doppler if conservative management planned

Question 26

When should a CTG be repeated in severe gestational hypertension?

Answer 26

If woman reports any: - Change in fetal movement - Vaginal bleeding - Abdominal pain - Deterioration in maternal condition

Question 27

What monitoring should take after birth for gestational hypertension?

Answer 27

- BP for first 2 days | - BP once between days 3-5

Question 28

When should antihypertensive medication be stopped?

Answer 28

Reduce as BP falls after birth

Question 29

What changes should be made if treating gestational hypertension with methyldopa?

Answer 29

Switch at most 2 days after delivery

Question 30

What % of women with gestational hypertension before 34 weeks will go on to develop pre-eclampsia?

Answer 30

40%

Question 31

What are hypertensive disorders of pregnancy (including gestational hypertension) a risk factor for?

Answer 31

Cardiovascular disease in later life

Question 32

What future management is recommended after delivery with gestational hypertension?

Answer 32

- Lifestyle modification - Regular BP control - Control of metabolic factors

Question 33

Why is ongoing management recommended after gestational hypertension?

Answer 33

To reduce the risk of further complications in future pregnancies and reduce cardiovascular risk