HYPERTENSIVE DISORDERS IN PREGNANCY

Question 1

What is acute severe hypertension?

Answer 1

Diastolic BP of ≥ 110 mmHg and/or systolic BP ≥ 160 mmHg.

Question 2

What are the maternal features of severe hypertensive disease?

Answer 2

Any one or more of the following:
- Acute severe hypertension
- New-onset severe headache unresponsive to medication
- Visual disturbances
- Thrombocytopenia (platelet count <100 000/uL)
- Impaired liver function (ALT or AST >40 IU/L)
- Severe persistent right upper quadrant or epigastric pain
- HELLP syndrome (platelets <100 000 and AST >70 ul and LDH >600 ul)
- Serum creatinine ≥120 micromole/L
- Pulmonary edema.

Question 3

What is HELLP syndrome?

Answer 3

A condition characterized by platelets <100 000, AST >70 ul, and LDH >600 ul.

Question 4

What is thrombocytopenia?

Answer 4

A condition where the platelet count is <100 000/uL.

Question 5

What indicates impaired liver function in severe hypertensive disease?

Answer 5

ALT or AST levels >40 IU/L.

Question 6

What serum creatinine level indicates concern in severe hypertensive disease?

Answer 6

Serum creatinine ≥120 micromole/L.

Question 7

Women at risk for the development of pre-eclampsia

Answer 7

• ANY pregnant women CAN develop pre-eclampsia. Those most at risk are antenatal attendees who have at
least one of the features below:
• primigravidae, in particular teenagers
age 35 years and above
previous pregnancy complicated by HDP
previous abruptio placentae or unexplained intra-uterine death
multiple pregnancies
medical complications such as chronic hypertension, renal disorders, diabetes, connective tissue
disorders or antiphospholipid syndrome
• obesity
• women who develop edema in the mid trimester or have excessive or rapid weight gain

Question 8

PET prevention

Answer 8

The following may help to reduce the chance of a women getting pre-eclampsia:
Calcium supplementation to all pregnant women:

1 gram elemental calcium in divided doses (e.g. calcium carbonate, oral, 500 mg 12 hourly or 1 g in the
morning).

For women at high risk of pre-eclampsia, e.g. pre-eclampsia in a previous pregnancy, chronic hypertension or diabetes:
Aspirin 150mg taken at bedtime (at night - to prevent gastric irritation) from 6 weeks of gestation (but
preferably before 16 weeks) until 36 weeks.