Elevated bp

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Initial Workup for Dx of BP>140/90

[ ] <20 weeks & Asx. = CMP, 24hr urine protein w/ creatinine clearance, EKG, 2D Echo and ophtho, GTT, MFM referral & consider Secondary HTN causes.

[ ] >20 weeks = Suggest Hospital Triage with emergent transport if symptomatic. CBC, CMP, LDH, Uric Acid, 24hr urine protein, or Spot urine prot:creat ratio (Consider addition of <20 week testing if time / situation permits).

Elevated Blood Pressure in Pregnancy Diagnosis

[ ] C-HTN (Noticed <20 weeks w/ BP >140/90)

[ ] G-HTN (Noticed >20 weeks w/ BP >140/90 without 300mg/24hr of proteinuria)

[ ] Pre-eclampsia w/o Severe Features (>140/90 with >300mg/24hr of proteinuria, >0.3 on spot urine protein:creatinine ratio, Asx. otherwise)

[ ] Preeclampsia w/ Severe Features (Systemic Sx=Headaches, IUGR, Pulm Edema, Renal Insuff, BP>160/90, dont wait for protein)

[ ] Superimposed Preeclampsia on Chronic Hypertension (Increase in BPs, Proteinuria, or Sx.)

[ ] Eclampsia / HELLP (Seizure, Plt<100k, Abnl AST, LDH>600 or Seizure, Abnl Smear)

Prenatal Plan for C-HTN

[ ] Fetal Anatomy U/S @ 20 weeks, Growth Scan q4 weeks after 24weeks

[ ] Screen for 2ndary HTN - Resistent HTN, K <3.0, Cr >1.1, Strong fam hx of CKD

[ ] CBC, CMP, 24hr urine protein every trimester.

[ ] C-HTN =BP140-159/90-109, no medication unless evidence of End-Organ Damage. // If BP >160/110, consider Rx Nifedipine 30mg XL daily, Labetalol 200mg PO BID, Methyldopa 250mg PO TID.

[ ] Daily Kick Counts

[ ] Biweekly Antenatal Testing @ 28-32 weeks.


[ ] Delivery no earlier than 38 weeks (consider at this time).


Prenatal Plan for GHTN / Preeclampsia / HELLP / Eclampsia

References

ACOG 2013 HTN in Preg

Zheng Redbook Obstetrics & Gynecology

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