Makindo Medical Notes

Introduction

• Hypertension in pregnancy is usually defined as systolic BP > 140 mmHg or diastolic BP > 90 mmHg.
• Alternatively, an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic.

Classification of Hypertension in Pregnancy

• Pre-existing Hypertension:
  • A history of hypertension before pregnancy or elevated BP > 140/90 mmHg before 20 weeks gestation.
  • No proteinuria or oedema.
  • Occurs in 3-5% of pregnancies, more common in older women.
• Pregnancy-induced Hypertension (PIH) or Gestational Hypertension:
  • Hypertension occurring in the second half of pregnancy (after 20 weeks).
  • No proteinuria or oedema.
  • Occurs in about 5-7% of pregnancies.
  • Resolves after birth (usually within a month), but women with PIH are at increased risk of future pre-eclampsia or hypertension later in life.
• Pre-eclampsia:
  • Pregnancy-induced hypertension associated with proteinuria (> 0.3g / 24 hours).
  • Oedema may occur but is now less commonly used as a criterion.
  • Occurs in approximately 5% of pregnancies.

Symptoms of Pre-eclampsia

Advise pregnant women to seek medical attention immediately if they experience symptoms of pre-eclampsia, including:

• Severe headache.
• Vision problems, such as blurring or flashing lights.
• Severe pain just below the ribs.
• Vomiting.
• Sudden swelling of the face, hands, or feet.

Antiplatelet Agents

Advise pregnant women at high risk of pre-eclampsia to take 75-150 mg of aspirin daily from 12 weeks until birth. Women at high risk include those with:

• Hypertensive disease during a previous pregnancy.
• Chronic kidney disease.
• Autoimmune disease, such as SLE or APLS syndrome.
• Type 1 or type 2 diabetes.
• Chronic hypertension.

Moderate Risk of Pre-eclampsia

Women with more than one moderate risk factor for pre-eclampsia should take 75–150 mg of aspirin daily from 12 weeks until birth. Moderate risk factors include:

• First pregnancy.
• Age 40 years or older.
• Pregnancy interval of more than 10 years.
• Body Mass Index (BMI) ≥ 35 kg/m² at first visit.
• Family history of pre-eclampsia.
• Multi-fetal pregnancy.

References

• NICE Guidance on Hypertension in Pregnancy