Makindo Medical Notes

🌸 Introduction

• Hypertension in pregnancy = BP ≥ 140/90 mmHg.
• Also significant if rise from booking baseline: +30 mmHg systolic or +15 mmHg diastolic.

🗂️ Classification of Hypertension in Pregnancy

• 💙 Pre-existing (Chronic) Hypertension:
  • Present before pregnancy or detected before 20 weeks.
  • No proteinuria or oedema.
  • Affects ~3–5% of pregnancies, ↑ risk with older mothers.
• 💛 Pregnancy-induced / Gestational Hypertension:
  • New hypertension after 20 weeks.
  • No proteinuria or oedema.
  • Occurs in ~5–7% of pregnancies.
  • Usually resolves within 1 month postpartum, but ↑ future risk of pre-eclampsia or chronic HTN.
• ❤️ Pre-eclampsia:
  • Hypertension + proteinuria (>0.3 g/24h).
  • Oedema sometimes present (not essential for diagnosis).
  • Occurs in ~5% of pregnancies; risk of maternal & fetal complications.

⚠️ Symptoms of Pre-eclampsia

Pregnant women should seek urgent help if they experience:

• 💥 Severe headache.
• 👀 Visual changes (blurring, flashing lights).
• ⚡ Severe epigastric / RUQ pain.
• 🤢 Vomiting.
• 💧 Sudden swelling of face, hands, or feet.

💊 Antiplatelet Agents

Women at high risk of pre-eclampsia → aspirin 75–150 mg daily from 12 weeks until delivery.

• Previous hypertensive disorder of pregnancy.
• Chronic kidney disease.
• Autoimmune disease (SLE, antiphospholipid syndrome).
• Type 1 or 2 diabetes.
• Chronic hypertension.

🟨 Moderate Risk of Pre-eclampsia

If a woman has ≥2 moderate risk factors, start aspirin 75–150 mg daily from 12 weeks until delivery.

• First pregnancy.
• Age ≥ 40 years.
• Pregnancy interval > 10 years.
• BMI ≥ 35 at booking.
• Family history of pre-eclampsia.
• Multiple pregnancy (twins/triplets).

📚 References

• NICE Guidance on Hypertension in Pregnancy

Clinical cases

• 🤰 Case 1 – Age 28 (Gestational Hypertension): First pregnancy at 32 weeks; routine check revealed BP 148/95 mmHg with normal urine dipstick and bloods. No headache or visual symptoms. Diagnosis: Gestational hypertension (new-onset hypertension after 20 weeks without proteinuria). Management: Started on oral labetalol, weekly BP and urine checks, and growth scans every 2–4 weeks. Teaching point: Gestational hypertension can progress to pre-eclampsia — close surveillance of BP, urine protein, and fetal growth is essential.
• 🩺 Case 2 – Age 35 (Pre-eclampsia): At 30 weeks, presented with headache and visual disturbance. BP 170/110 mmHg, urine 3+ protein, reflexes brisk. Investigations: Raised urate and abnormal LFTs; normal platelets. Diagnosis: Pre-eclampsia. Management: Hospital admission, IV labetalol to control BP, magnesium sulphate prophylaxis, and corticosteroids for fetal lung maturity. Teaching point: Pre-eclampsia is due to abnormal placental vascular development causing endothelial dysfunction and multi-organ effects — delivery is the definitive cure.
• 💊 Case 3 – Age 39 (Chronic Hypertension in Pregnancy): Known hypertensive on amlodipine before conception. Early antenatal visit at 10 weeks with BP 142/92 mmHg, normal urine, normal renal function. Management: Switched to labetalol (safe in pregnancy) and started low-dose aspirin from 12 weeks to reduce pre-eclampsia risk. Outcome: Controlled BP throughout pregnancy, delivered at term. Teaching point: Women with pre-existing hypertension need medication review pre-pregnancy — ACE inhibitors and ARBs must be stopped due to teratogenicity.