Hypertension in Pregnancy - lecture slides

Slide 1: Hypertension in Pregnancy

Slide 2: Objectives Risk assessment for hypertension in pregnancy Hypertensive disorders in pregnancy Complications - maternal/ Foetal Diagnosis and monitoring in pregnancy Treatment Postpartum follow up Counselling - advice on lifestyle and long-term health implications

Slide 3: Blood pressure Pressure of blood exerted in the arteries between the cardiac contractions Systolic – measured when the heart contracts (highest) Diastolic – measured when cardiac muscle relaxes (lowest) Arterial BP = PVR x CO(HR x SV)

Slide 4: What happens in pregnancy Vasodilation Mediators such as NO & progesterone Reduction in systemic vascular resistance Plasma volume increases Augmentation of renin-angiotensin-aldosterone system Increase SV & HR

Slide 5: Placental perfusion This creates a high flow, low resistance circulation that maximises maternal blood flow to the placental villi at the maternal–fetal interface

Slide 6: Initial appointment - booking Ask about PMH Including medications Ask about past pregnancies Take BP & dip urine

Slide 7: 12/40 Dating scan uterine artery doppler interpretation - Google Search Show placental function assessment Aspirin and growth scans arranged according to output Women with pre-existing hypertensive disease are classified as high risk

Slide 9: Hypertensive disorders of Pregancy Pre-existing High risk for superimposed PET Pre-Eclampsia (PET) Hypertension >140/90 Proteinuria Pregnancy Induced Hypertension Hypertension > No proteinuria

Slide 10: Risk factors High Risk Previous Hypertensive disease in Pregnancy Chronic Kidney Disease Some autoimmune disorders Inflammatory disorders Pre-existing diabetes Chronic hypertension Moderate Risk Nulliparity Age >40yrs Pregnancy interval >10yrs BMI >35 FH Pre-eclampsia 1st degree relative Multiple birth

Slide 11: Pre-eclampsia Condition with signs of end organ damage Mostly will resolve soon after delivery Is a disease of placentation Very rare before 20/40 Most onset late 3rd trimester

Slide 13: Complications - maternal Stroke Seizures Pulmonary oedema Acute kidney injury Inflammation of the liver Clotting abnormalities HELLP Pre-eclampsia | Tommy's (tommys.org)

Slide 17: Fetal complications Fetal Growth Restriction Intrauterine Fetal Death Preterm delivery Neonatal Death Long-term sequalae HTN CVD Diabetes

Slide 18: Monitoring

Slide 19: Parrot trial Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial - PubMed

Slide 20: Treatment Depends on gestation & severity Admit Bloods – FBC/U&E/LFTs/Cls CTG & USS – fetal wellbeing Regular observations Commence antihypertensives If pre-term delivery is indicated if Uncontrollable/severe hypertension Signs of end organ damage

Slide 21: Severe Pre-eclampsia Is a medical emergency MDT management Stabilise mother Magnesium IV antihypertensive Consider fetus Magnesium Steroids Delivery when stable

Slide 22: Post-natally Inpatient normally 48 hours Regular monitoring in community for 2/52 FU with GP & CMW Can consider switching to once daily formulation

Slide 25: The future Left ventricular remodelling Left ventricular mass increase significantly more in hypertensive pregnancies Can this be treated?......

Slide 26: Quiz How many types of hypertensive disease What is the diagnostic cut off for hypertension Name one maternal effect Name one fetal effect Who’s guidance do we follow for treatment of hypertension

Slide 27: Questions