HYPERTENSION IN PREGNANCY

Definitions

100

BP >140/90 on at least 2 occasions, 4 hours apart with normal laboratory findings, patient asymptomatic

Gestational hypertension

200

Hypertension present before pregnancy or diagnosed before 20 weeks gestation

Chronic hypertension

300

BP >140/90 on at least two occasions greater than 4 hours apart with proteinuria, no other laboratory abnormalities, patient asymptomatic

Preeclampsia without severe features

400

BP >140/90 on at least two occasions more than 4 hours apart with proteinuria AND BP >160/110 requiring treatment with antihypertensives, symptoms (persistent headache, vision changes, shortness of breath, chest pain, RUQ pain, nausea/vomiting, acute edema) not attributed to alternative cause, or laboratory abnormalities (eg LFTs >2x upper limit of normal)

Preeclampsia with severe features

500

New onset seizure during pregnancy or postpartum not related to other cerebral condition

Eclampsia

Chronic Hypertension

100

Threshold for treatment in pregnancy

140/90

200

2 common oral anti-hypertensives used in pregnancy

Labetalol

Nifedipine

300

Diagnosis: New-onset proteinuria, new and persistent severe range BP, LFT >2x normal, thrombocytopenia

Chronic hypertension with superimposed preeclampsia with severe features

400

Delivery timing when controlled on medications

37 to 39 weeks gestation

500

Delivery timing when severe range BP or concern for superimposed preeclampsia with severe features

34 weeks or at time of diagnosis

Miscellaneous

100

Medication used for prophylaxis

81mg aspirin

200

When to start prophylaxis

12 to 28 weeks (continued through delivery)

300

Three risk factors for hypertensive disorders of pregnancy

Nulliparity, multiple gestation, history of preeclampsia, obesity, chronic hypertension, pregestational and gestational diabetes, advanced maternal age, obstructive sleep apnea, thrombophilia, SLE, anti-phospholipid syndrome, kidney disease, assisted reproductive technology

400

Definition of proteinuria

Urine protein to creatinine ratio > 0.3

24 hour urine protein >300

Dipstick 2+ (in settings without access to above methods)

500

Definition of HELLP

Hemolysis: Abnormal peripheral blood smear (schistocytes, burr cells, echinocytes), Increased bilirubin >1.2, Increased LDH >600 IU/L 

Elevated LFTs Increased AST/ALT to >2x upper limit of normal

Platelet count < 100,000/mm3

Management

100

Delivery timing for preeclampsia without severe features or gestational hypertension

37 weeks

200

Delivery timing for preeclampsia with severe features

34 weeks or sooner if worsening maternal/fetal status

300

When to recommend magnesium prophylaxis?

Chronic hypertension with superimposed preeclampsia with severe features

Preeclampsia with severe features

HELLP

Eclampsia

400

When to treat with IV antihypertensives?

Persistent severe range >160/110, 15 minutes apart

500

IV antihypertensive regimens

IV labetalol 20 > 40 > 80

IV hydralazine 5 > 10

PO Nifedipine IR 10-20mg

Magnesium

100

Duration for magnesium treatment

delivery > 24 hours postpartum

200

Typical IV dosages

6mg bolus, then 2mg/hr

300

Dosage and route if no IV access

IM injection of 5mg in each buttock, total 10mg as "bolus"

then 5mg every 4 hours

400

Therapeutic range

4.8-9.6 mg/dL

500

First sign of magnesium toxicity and reversal method

Loss of deep tendon reflexes

Calcium gluconate 10% solution