Question

Hypertension Nancy is a chronic hypertensive patient who has been seen at your clinic for 5 years. She is happy today when she reports that she is 2 months pregnant and would like a referral to a nurse midwife for prenatal care. She has never had issues with her blood pressure after she quickly adapted to a calcium channel blocker and diuretic for her treatment. She does get a bit of dependent edema at the end of the day that remains less than 1+ and typically ""gives me an excuse to put my feet up!"" She comes with several printouts about pre-eclampsia from the Internet. She is asking for a urine sample to check for protein because she ""does not want a C-section.""

1. Would Nancy fit the mold for referral to a midwife for routine pregnancy care? Consider your nurse practice act for degree of complexity handled by certified nurse midwives in your state.
2. Is she correct in her assumption that she has pre-eclampsia? Compare and contrast the presentation of pregnancy-related edema and the side effects of calcium channel blockers (SE of CCBs).
3. Is she currently on any medications that must be stopped today before she sees an obstetrician/gynecologist? Review how prescribers can find information on pregnancy categories.
4. What are the categories of hypertension (HTN) medications typically given to women with pre-existing HTN who become pregnant? There are both classic medications and newer therapies to consider.

Answer 1

Nancy may qualify for referral to a midwife for routine pregnancy care, but further evaluation is needed to determine if she has pre-eclampsia. She should not stop her medications without consulting her healthcare provider. The categories of hypertension medications given to pregnant women with pre-existing hypertension include both classic medications and newer therapies.

Step-by-step explanation:

Nancy would likely fit the mold for referral to a midwife for routine pregnancy care, as long as her condition remains stable and within the scope of practice for certified nurse midwives in your state. It is important to consult your nurse practice act to determine the specific degree of complexity that can be handled by midwives.

It is premature for Nancy to assume that she has pre-eclampsia. Pregnancy-related edema, which Nancy experiences, is a common symptom during pregnancy and does not necessarily indicate pre-eclampsia. On the other hand, the side effects of calcium channel blockers, which Nancy takes for her hypertension, can also cause edema as a side effect. To determine if she has pre-eclampsia, further evaluation, including urine protein testing, would be necessary.

Nancy should not stop taking her medications without consulting her healthcare provider. Prescribers can find information on pregnancy categories, which indicate the safety of medications during pregnancy, by referring to reputable sources such as the Food and Drug Administration or the American College of Obstetricians and Gynecologists.

The categories of hypertension medications typically given to women with pre-existing hypertension who become pregnant include both classic medications, such as methyldopa and labetalol, and newer therapies like nifedipine. The selection of medications depends on various factors, including the severity of hypertension and the patient's individual needs.