134 Obstetrics and Gynecology Board Review •••
❍ Is chemical or electrical cardioversion safer for supraventricular tachycardia in pregnancy?
Adenosine for termination of supraventricular tachycardia is considered safe in pregnancy. Electrical cardioversion
must be approached with caution; it has been reported to lead to sustained uterine contractions and prolonged
fetal heart rate deceleration.
❍ What lifestyle modifications are recommended for patients with chronic hypertension?
Weight reduction, restriction of dietary sodium and fat, physical activity, limitation of alcohol consumption, and
smoking cessation.
❍ What workup is recommended for pregnant women with chronic hypertension?
Ophthalmologic evaluation and echocardiogram in any patient with prolonged hypertension or prior
complications, 24-hour urine protein, and serum creatinine.
❍ What is the maternal mortality rate for women with chronic hypertension?
230 per 100,000 live births.
❍ What are the risk factors for the development of superimposed preeclampsia in patients with chronic
hypertension?
Prolonged hypertension (>4 years) and history of superimposed preeclampsia in previous pregnancy.
❍ Chronic hypertension increases the risk of which pregnancy outcomes?
Intrauterine growth restriction, preterm delivery, infant NICU admission, and perinatal mortality.
❍ At what blood pressure, should medication be started for chronic hypertension?
Systolic 150 to 160 mmHg or diastolic 100 to 110 mmHg.
❍ What medications are recommended for management of chronic hypertension in pregnancy?
Labetalol, methyldopa, and nifedipine are used most often. Diuretics are not recommended due to the theoretical
risk of decreased volume expansion in pregnancy. Angiotensin-converting enzyme inhibitors are teratogenic and are
contraindicated in pregnancy.
❍ What is the rate of superimposed preeclampsia in patients with chronic hypertension?
Approximately 25%.
❍ How is the diagnosis of superimposed preeclampsia made?
New onset neurologic symptoms, proteinuria, oliguria, elevated transaminases, or low platelets are suggestive
of superimposed preeclampsia. Increasing blood pressures in the third trimester are not necessarily due to
superimposed preeclampsia, and antihypertensive medications may be initiated or increased in the absence of other
signs or symptoms of preeclampsia.
❍ When should delivery be planned for women with chronic hypertension?
If the hypertension is well controlled, it is safe to await labor at term.