Hypertension in Pregnancy

Question 1

How is HTN diagnosed in pregnancy?

Answer 1

Blood pressure >140/90
Systolic BP increases by 300mmHG or more
Diastolic BP increases by 15mmHg or more

Question 2

How is HTN classified?

Answer 2

Pre-existing HTN
- Previous diagnosed HTN or HTN diagnosed <20 weeks

Pregnancy induced HTN
- HTN diagnosed >20 weeks usually resolves post delivery
- does increase risk of PET in future

Pre-eclampsia
- HTN and Proteinuria
- Oedema can develop

Question 3

What is the management of HTN in pregnancy?

Answer 3

If pre-existing and on ACEi or ARB then stop and switch to labetalol or equivalent

1) Labetalol
2) Nifedipine (if asthmatic) or hydralazine

Question 4

What are high risk factors for PET?

Answer 4

HTN in previous pregnancy
Pre existing diagnosis of HTN
Background of autoimmune disease such as SLE or Anti-phospholipid
CKD
Diabetes T1 and T2

Prescribe all 75-150mg aspirin from 12 weeks until birth

Question 5

What are moderate risk factors for PET?

Answer 5

1st Pregnancy
Age >40
Pregnancy interval >10 years
BMI >35
FH of PET
Multiple pregnancy

If 2 or more of these then aspirin to be provided

Question 6

What are features of PET?

Answer 6

HTN typically >160/110
Proteinuria
Headache
Visual disturbance
Papilloedema
RUQ/epigastric pain
Hyperreflexia
Platelet count <100 or HELLP

Question 7

What is the management of PET?

Answer 7

Only cure is delivery

Manage until delivery
-Aspirin 75-150mg 12 weeks till birth
- Labetalol (or alternatives if required)
- Severe PET Magnesium

Question 8

What are potential complications of PET?

Answer 8

Eclampsia
- neurological complications including seizures, blindness, stroke
- treat with 4g bolus Mag sulfate and then 1g/hour infusion

Foetal complications
- IUGR
- Pramturity

Liver
- HELLP syndrome
– haemolytic anaemia
– Elevated Liver enzymes
– Low platelets

Haemorrhage- placental abruption
Cardiac Failure