Useful notes (O&G, MFM)

Chronic hypertension

Pre-pregnancy

  • Optimise BP with a safe drug
  • Urinalysis, renal function, eye check
  • Investigate secondary causes
  • CV risk factors: smoking, diabetes, hyperlipidaemia, obesity, family history
  • Exercise, salt intake, diet
  • Contraception
  • Folic acid

Pregnancy

  • Set BP target (usually 135/85 mmHg)
  • Set schedule for BP monitoring
  • Aspirin 150 mg ON between 12-36 weeks
  • Serial growth scans (28, 32, 36)
  • Aim for birth at term (39+0-39+6, or earlier with other risk factors)
  • Risk of pre-eclampsia ~1 in 7

Delivery

  • CEFM on Delivery Suite only if indicated for other reasons
  • Avoid ergometrine

Postnatal

  • Stop methyldopa
  • Continue antihypertensives or switch to enalapril
  • GP 6-8 weeks after birth
  • Recommend pre-pregnancy counselling in future

Resources

Patient information:

https://www.nice.org.uk/guidance/ng133/resources/hypertension-in-pregnancy-diagnosis-and-management-pdf-8859693858757

https://www.nhs.uk/pregnancy/related-conditions/complications/high-blood-pressure/

Guideline:

https://www.nice.org.uk/guidance/ng133