Maternal Medicine - Hypertensive disease in pregnancy Flashcards
(49 cards)
What is the International Society of Hypertension in Pregnancy definition of pre-eclampsia?
Gestational hypertension of at least 140/90 mmHg on two separate occasions ≥4 hours apart accompanied by significant proteinuria of at least 300 mg in a 24-hour collection of urine, arising de novo after the 20th week of gestation in a previously normotensive woman and resolving completely by the 6th postpartum week.
Pre-eclampsia complicates what percentage of pregnancies?
2-8%
Pre-eclampsia causes what % of direct maternal deaths in the UK?
15%
How many women worldwide die of pre-eclampsia each year according to WHO?
70,000
What is the incidence of eclampsia?
2.5/10,000
What happens to placental growth factor in pregnnacy?
Increases, then decreases
Lower levels seen in pre-eclampsia
How many stillbirths without congenital abnormality occurred in mothers with pre-eclampsia?
5%
How many women in their first pregnancy will give birth below 34/40 as a result of pre-eclampsia?
1 in 250 (0.4%)
How many preterm births are from hypertensive disorders?
8-10%
How many pre-term and term births <10th centile are to women with pre-eclampsia?
20-25% preterm
14-19% term
What are the ‘high risk’ factors for pre-eclampsia?
Hypertensive disease in previous pregnancy CKD Autoimmune disease (e.g. SLE, APS) T1 or T2 diabetes Chronic hypertension
What BP limit should be aimed for in chronic hypertension?
And with evidence of target-organ damage?
150/100 (diastolic not lower than 80)
140/90
When should all women with pre-eclampsia have a medical review postnally?
6-8/52
What is the risk of developing gestational hypertension following a pregnancy complicated by pre-eclampsia?
13-53% (1 in 8 to 1 in 2)
What is the risk of developing PET following a pregnancy complicated by PET?
16% (1 in 6)
What is the risk of developing PET following a pregnancy complicated by severe PET, HELLP or eclampsia leading to birth <34/40?
25%
What is the risk of developing PET following a pregnancy complicated by PET leading to birth <28/40?
55%
What are the moderate risk factors for PET?
First pregnancy Age >40 Pregnancy interval >10 years FHx PET BMI => 35 at booking Multiple pregnancy
When should women with chronic hypertension/gestational hypertension be delivered?
Not before 37/40 if BP < 160/110, with or without antihypertensive treatment
What is the PN follow up for women with chronic hypertension?
BP measurement:
OD first 2/7, at least once D3-5, then as clinically indicated if antihypertensive changed
Review treatment 2/52 after delivery; aim BP <140/90
Review at 6-8/52
How are women with mild gestational hypertension managed?
Not admitted/treated
BP once a week
Test proteinuria each visit
Routine antenatal bloods
If high risk/<32/40 - BP and urine twice weekly
How are women with moderate gestational hypertension managed?
Not admitted Commence labetalol (aim <150/80-100) BP twice weekly Proteinuria test each visit Test bloods - no further unless proteinuria develops
How are women with severe gestational hypertension managed?
Admit until BP =<159/109 Labetalol (aim <150/80-100) BP QDS Daily proteinuria test Bloods at presentation, then weekly
Once discharged - BP and urine twice weekly, blood tests weekly
What is the postnatal follow up for women with gestational hypertension?
BP measurement:
OD first 2/7, at least once D3-5, then as clinically indicated if antihypertensive changed
Consider reducing Rx if <140/90; reduce if <130/80
Start treatment if >149/99
Medical review at 2/52 if still on treatment
Review at 6-8/52 - if still on treatment refer for speciaslist assessment of their hypertension
