Each delivery unit should maintain standardized policy and procedure regarding the management of hypertensive disorders of pregnancy. Abanoub gabra, department of obstetrics and gynecology, assuit university, egypt. Pdf management of hypertensive disorders in pregnancy. Hypertensive disorders of pregnancy embrace a variety of definitions as shown below. Guidelines for the management of hypertensive disorders of pregnancy 2014 lowe sa, bowyer l, lust k, mcmahon l, morton m, north ra, paech m. Aug 25, 2010 this guideline has been updated and replaced by hypertension in pregnancy. Ambulance service of nsw and all other retrieval services must also have protocols for the management of hypertensive disorders of pregnancy based on this policy directive. Special consideration should be given toward the development of guidelines and order sets for the management of acute onset of severe hypertension with preeclampsia or eclampsia 2. Discuss the treatment of hypertensive disorders of pregnancy. These same agents may be used for treating gestational or chronic hypertension. Guidelines for the management of hypertensive disorders of pregnancy.
For example, the terms toxemia, gestosis, pregnancy induced hypertension, and preeclamptic toxemia have each been used to. Management of gestational hypertension is similar to that of preeclampsia, with expectant monitor ing and labor induction at 37 weeks gestation. Hypertensive disorders of pregnancy journal of obstetric. Current best practice in the management of hypertensive. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.
Lowe sa, brown ma, dekker ga, gatt s, mclintock ck, mcmahon lp, et al. This guidance has been updated and replaced by nice guideline ng3. This document is not intended to replace clinical judgment in the care of women with hypertensive disorders in pregnancy. Hypertension during pregnancy learning objectives differentiate the four categories of hypertensive disorders of pregnancy. Diagnosis, evaluation, and management of the hypertensive. Stabilization of maternal status with magnesium sulfate and antihypertensive therapy is recommended. It should be noted that diagnostic and management strategies that are not recommended specifically for their impact on outcomes of. Maternity management of hypertensive disorders of pregnancy. Welcome to the pregnancy medical home first tuesdays. The causes of preeclampsia and the optimal clinical management of the hypertensive disorders of pregnancy remain. Current best practice in the management of hypertensive disorders in pregnancy rosemary townsend,1 patrick obrien,2 asma khalil1 1fetal medicine unit, st georges university of london, london, uk.
These are the recommendations of a multidisciplinary working party convened by the society. Pdf guidelines for the management of hypertensive disorders. Hypertensive disorders during pregnancy are classified into 4 categories, as recommended by the national high blood pressure education program working group on high blood pressure in. Diagnosis and management of hypertension in pregnancy. Here, i address the management of mild gestational hypertension ghtn and preeclampsia without severe features, which i believe should be managed similarly. Magnesium sulphate management of hypertensive disorders of. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. The management of hypertensive disorders of pregnancy. Hypertensive disorders of pregnancy hypertension aha journals. A graphical representation of normal cardiovascular changes in pregnancy. This guideline covers diagnosing and managing hypertension high blood pressure, including preeclampsia, during pregnancy, labour, birth and immediately after birth. Hypertensive disorders of pregnancy australian prescriber. Management of hypertensive disorders in pregnancy mdedge. Purpose this document outlines the guideline or procedure details for the indications, contraindications, administration and monitoring of magnesium sulfate sulphate use at the womens.
Global burden of disease, pathophysiology, risk factors, reducing the risk of hypertensive disorders in pregnancy, diagnosis, complications, monitoring, management, breast feeding and antihypertensives, care of women in the postnatal period. Management of hypertensive disorders in pregnancy an evidence based approach. Investigation of new onset hypertension after 20 weeks 9 5. Management of hypertensive disorders in pregnancy request pdf. The impact of high blood pressure on pregnancy is related more to the underlying pathology of the condition than to the actual elevation in pressure. Making decisions using nice guidelines explains how we use words to show the. Postpartum management of hypertensive disorders of pregnancy. Among the hypertensive disorders that compli cate pregnancy, preeclampsia and eclampsia stand out as major causes of maternal and perinatal mortality and morbidity. Clinical practice guideline the management of hypertension in pregnancy 6 management of hypertensive disorders during pregnancy in the antenatal, intrapartum and postnatal periods. These disorders are an important cause of maternal and fetal morbidity and mortality. Hypertension in pregnancy nice clinical guideline 107. Hypertensive disorders of pregnancy can be subclassified into four groups chronic hypertension, gestational hypertension, preeclampsia, and superimposed preeclampsia in the setting of chronic hypertension, as laid out in the acog american congress of obstetricians and gynecologists guideline.
Hypertensive disorders of pregnancy american family. Current data suggest improved perinatal outcomes with expectant. Beyond 34 weeks, delivery is indicated for women with severe preeclampsia, and those with unstable maternalfetal conditions. Guideline for the management of hypertensive disorders of. Here, i address the management of mild gestational hypertension ghtn and preeclampsia without severe features, which i believe should be managed. Chronic hypertension hypertension that is present at the booking visit or before 20 weeks gestation, or if the woman is already taking antihypertensive medication when starting maternity care. A normal blood pressure may be recorded between 16 and 20 weeks, even in a woman with chronic hypertension, because of the systemic vasodilation in pregnancy. Figure 3 summarizes management of hypertensive disorders in pregnancy associated with severe features. Management of hypertensive disorders in pregnancy an evidence based approach dr. Hypertensive disorders of pregnancy, pregnancy related hypertension, pregnancy induced hypertension, hypertension induced by pregnancy, gestational hypertensionpreeclampsia, preeclampsia, pih, eph gestosis, preeclampsia.
Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy laura a. Management of hypertensive disorders of pregnancy webinar will begin at 7. Preeclampsia is a potentially serious complication of pregnancy with. Guidelines for selecting antihypertensive drug treatment in pregnancy. National institute for health and clinical excellence. Although the rate of eclampsia in the united kingdom uk appears to have fallen, hypertension in pregnancy remains one of the leading causes of maternal death in the uk2. Hypertensive disorders represent one of the most common medical complications of pregnancy. Executive summary this document reflects emerging clinical and scientific advances on the date issued and is subject to change. Guideline for the management of hypertensive disorders. Page 1 of 5 updates in management of hypertensive disorders of pregnancy abanoub gabra1 and mariam gabra2 1department of obstetrics and gynecology, assuit university, egypt 2hillsborough community college, florida, usa corresponding author. Hypertensive disorders during pregnancy carry risks for the woman and the baby. Request pdf management of hypertensive disorders in pregnancy hypertensive disorders are the most common medical complication of pregnancy, with an incidence of 510%, and a common cause of.
Management rdless of the hypertensive disorder of pregnancy, re bp requires urgent treatment in a monitored setting when severe 160110 mm hg. Hypertensive disorders of pregnancy hdp affect one in ten pregnancies and often persist postpartum when complications can occur. Updates in management of hypertensive disorders of. The management of hypertension in pregnancy advances in. Magnesium sulfate management of hypertensive disorders of pregnancy uncontrolled document when printed published. Early diagnosis and careful monitoring of patients with preeclampsia is the corner stone in management. Jan 15, 2016 hypertensive disorders affect up to 10% of pregnancies in the united states. The somanz guidelines for the management of hypertensive disorders of. Classification of the hypertensive disorders of pregnancy glowm. Hypertensive disorders of pregnancy american family physician. Blood pressure should be recorded either prepregnancy or in early pregnancy, before the nadir in blood pressure in the second trimester. The somanz guideline for the management of hypertensive.
Unit structure each delivery unit should maintain standardized policy and procedure regarding the management of hypertensive disorders of pregnancy. Current guidelines differentiate between the treatment of women with acute hypertensive syndromes of pregnancy and. These guidelines are intended for healthcare professionals, particularly. Jan 24, 2019 in the last installment of the master class, i addressed the importance of clarity in the classification of hypertensive disorders in pregnancy, and proposed several key diagnostic definitions. Hypertensive disorders of pregnancy refer to online version, destroy printed copies after use page 4 of 32 flowchart. Guidelines for the management of hypertensive disorders of pregnancy article pdf available in australian and new zealand journal of obstetrics and gynaecology 493. Hypertension is the most common medical problem encountered during pregnancy, complicating 23% of pregnancies. Hypertensive pregnancy disorders complicate 6% to 8% of pregnancies and cause significant maternal and fetal morbidity and mortality.
We aimed to determine the effectiveness and safety of pharmacological interventions, other interventions and different care models for postpartum hypertension management. Review diagnosis, evaluation, and management of the hypertensive disorders of pregnancy laura a. Pdf updates in management of hypertensive disorders of. Objectives hypertensive disorders of pregnancy hdp affect one in ten pregnancies and often persist postpartum when complications can occur.
Hypertensive disorders in pregnancy without severe features antepartum management all women diagnosed with hypertension in pregnancy should have a complete blood count, serum creatinine, liver enzymes, 24h urine collection or urine protein to creatinine ratio to assess for urine protein. Nnepqin guideline for the management of hypertensive. Pdf on may 28, 2019, abanoub gabra and others published updates in management of hypertensive disorders of pregnancy find, read. In the last installment of the master class, i addressed the importance of clarity in the classification of hypertensive disorders in pregnancy, and proposed several key diagnostic definitions. Oral labetalol may be used if these treatments are unavailable. It includes recommendations for women with chronic hypertension who wish to. Hypertension in pregnancy nice clinical guideline 107 this clinical guideline contains recommendations for the diagnosis and management of hypertensive disorders during pregnancy in the antenatal, intrapartum and postnatal periods. These documents are the primary basis for this guideline. Hypertensive disorders of pregnancy refer to online version, destroy printed copies after use page 3 of 1 introduction this document is a supplement to the queensland clinical guideline hypertensive disorders of pregnancy. Guidelines for the management of hypertensive disorders of pregnancy 2008 lowe sa, brown ma, dekker g, gatt s, mclintock c, mcmahon l, mangos g, moore mp, muller p, paech m, walters b. Fetal programming and fetal origins of adult disease theories extrapolate the benefit of such therapy to future generations. The goal of treatment is to prevent significant cerebrovascular and cardiovascular events in the mother without compromising fetal wellbeing. Thus, the optimal management of hypertensive disorders in pregnancy begins with an accurate diagnosis, as the treatment and prognosis vary significantly based on the etiology of the hypertension.
Obesity is strongly associated with hypertensive disorders of pregnancy, and there is evidence that bariatric surgery decreases the incidence of hypertension in pregnancy in obese women by. The management of hypertensive disorders of pregnancy 2014 lowe sa, bowyer l, lust k, mcmahon lp, morton m, north ra, paech m. Fetal surveillance in hypertensive diseases of pregnancy 19 8. Eclampsia remain a severe complication of preeclampsia and is associated with increased maternal. In early 2011, as the 62nd president elect of the american college of obstetricians and gyne. Management of women with hypertensive disorders of pregnancy august 2012 updated march 2014 a. List the risk factors for hypertension during pregnancy in particular, preeclampsia. An international journal of womens cardiovascular health aims to stimulate research in the field of hypertension in pregnancy, disseminate the useful results of such research. Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, preeclampsia. Hypertensive disorders of pregnancy queensland health.
These are the recommendations of a multidisciplinary working party convened by the society of obstetric medicine of australia and new zealand. The guideline is a partial update of the 2010 nice clinical guideline on hypertension in pregnancy. The quality of evidence reported in these guidelines has been adapted from the. Background preeclampsia is a leading cause of iatrogenic preterm birth. Hypertension is the most common disorder encountered in pregnancy and appropriate treatment was shown to reduce the risk of maternal hypertensive emergencies as well as complications in the newborn. Management of hypertensive disorders in pregnancy mdedge obgyn. Since the previous somanz guideline published in 2008, there has been significant international progress towards harmonisation of definitions in relation to both the diagnosis and management of preeclampsia and gestational hypertension. Hypertension in pregnancy bja education oxford academic. Hypertensive disorders affect up to 10% of pregnancies in the united states.
This page includes the following topics and synonyms. Request pdf management of hypertensive disorders in pregnancy hypertensive disorders are the most common medical complication of pregnancy, with an incidence of 5. This guideline has been updated and replaced by hypertension in pregnancy. Classifying hypertension in pregnancy caregivers have been and continue to be confused by the multiple terminologies, some complex and detailed, used to classify the hypertensive disorders of pregnancy. In the past, severe preeclampsia was treated by timely delivery. Classification of hypertensive disorders in pregnancy 5 4. Preeclampsia is a risk factor for future cardiovascu.
This guideline is an evidence based, practical clinical approach to the management of hypertensive disorders of pregnancy. Regardless of the hypertensive disorder of pregnancy, bps consistently at or 14090 mm hg in clinic or office or. The classification and diagnosis of the hypertensive disorders of pregnancy. Management of preeclampsia and gestational hypertension 11 6. Hypertensive disorders of pregnancy, including preeclampsia, complicate up to 10% of pregnancies worldwide, constituting one of the greatest causes of maternal and perinatal morbidity and mortality worldwide. Hypertensive disorders in pregnancy,pih, ghtn, preeclampsia, eclampsia, hellp syndrome,chronic hypertension slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Hypertensive disorders in pregnancy current practice. Definitions for hypertensive disorders of pregnancy. Somanz guidelines for the management of hypertensive. Hypertensive disorders in pregnancy hdp is not a preventable condition but early recognition and prompt treatment can prevent the development of both maternal and fetal morbidity and mortality. Management of hypertensive disorders in pregnancy hind n. Canadian hypertensive disorders of pregnancy working. The causes of preeclampsia and the optimal clinical management of the hypertensive disorders of pregnancy remain uncertain. Welcome to the pregnancy medical home first tuesdays webinar.
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