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. 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. Here, i address the management of mild gestational hypertension ghtn and preeclampsia without severe features, which i believe should be managed. Among the hypertensive disorders that compli cate pregnancy, preeclampsia and eclampsia stand out as major causes of maternal and perinatal mortality and morbidity. This guideline covers diagnosing and managing hypertension high blood pressure, including preeclampsia, during pregnancy, labour, birth and immediately after birth. Fetal surveillance in hypertensive diseases of pregnancy 19 8.
Hypertensive disorders of pregnancy australian prescriber. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. National institute for health and clinical excellence. 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. Guidelines for the management of hypertensive disorders of pregnancy. Pdf updates in management of hypertensive disorders of. Guidelines for the management of hypertensive disorders of pregnancy 2014 lowe sa, bowyer l, lust k, mcmahon l, morton m, north ra, paech m. Hypertensive disorders of pregnancy hdp affect one in ten pregnancies and often persist postpartum when complications can occur. A graphical representation of normal cardiovascular changes in pregnancy. These same agents may be used for treating gestational or chronic hypertension. Here, i address the management of mild gestational hypertension ghtn and preeclampsia without severe features, which i believe should be managed similarly. 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. Current best practice in the management of hypertensive.
The somanz guideline for the management of hypertensive. It should be noted that diagnostic and management strategies that are not recommended specifically for their impact on outcomes of. List the risk factors for hypertension during pregnancy in particular, preeclampsia. Maternity management of hypertensive disorders of pregnancy. Unit structure each delivery unit should maintain standardized policy and procedure regarding the management of hypertensive disorders of pregnancy. Pdf on may 28, 2019, abanoub gabra and others published updates in management of hypertensive disorders of pregnancy find, read.
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. 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. Magnesium sulfate management of hypertensive disorders of pregnancy uncontrolled document when printed published. The somanz guidelines for the management of hypertensive disorders of. Management rdless of the hypertensive disorder of pregnancy, re bp requires urgent treatment in a monitored setting when severe 160110 mm hg. 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. Jan 15, 2016 hypertensive disorders affect up to 10% of pregnancies in the united states. Review diagnosis, evaluation, and management of the hypertensive disorders of pregnancy laura a.
The goal of treatment is to prevent significant cerebrovascular and cardiovascular events in the mother without compromising fetal wellbeing. Fetal programming and fetal origins of adult disease theories extrapolate the benefit of such therapy to future generations. 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. This guideline has been updated and replaced by hypertension in pregnancy. Hypertensive disorders of pregnancy american family. These disorders are an important cause of maternal and fetal morbidity and mortality. Hypertensive disorders represent one of the most common medical complications of pregnancy.
Request pdf management of hypertensive disorders in pregnancy hypertensive disorders are the most common medical complication of pregnancy, with an incidence of 5. Blood pressure should be recorded either prepregnancy or in early pregnancy, before the nadir in blood pressure in the second trimester. Hypertensive disorders of pregnancy refer to online version, destroy printed copies after use page 4 of 32 flowchart. 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. For example, the terms toxemia, gestosis, pregnancy induced hypertension, and preeclamptic toxemia have each been used to. The causes of preeclampsia and the optimal clinical management of the hypertensive disorders of pregnancy remain.
Management of hypertensive disorders in pregnancy mdedge obgyn. Hypertensive disorders during pregnancy carry risks for the woman and the baby. Canadian hypertensive disorders of pregnancy working. Management of hypertensive disorders in pregnancy an evidence based approach dr. Each delivery unit should maintain standardized policy and procedure regarding the management of hypertensive disorders of pregnancy. Investigation of new onset hypertension after 20 weeks 9 5. 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. Hypertension during pregnancy learning objectives differentiate the four categories of hypertensive disorders of pregnancy. 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.
These are the recommendations of a multidisciplinary working party convened by the society of obstetric medicine of australia and new zealand. Hypertension in pregnancy bja education oxford academic. 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. Clinical practice guideline the management of hypertension in pregnancy 6 management of hypertensive disorders during pregnancy in the antenatal, intrapartum and postnatal periods. We aimed to determine the effectiveness and safety of pharmacological interventions, other interventions and different care models for postpartum hypertension management.
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. Hypertension in pregnancy nice clinical guideline 107. Oral labetalol may be used if these treatments are unavailable. Welcome to the pregnancy medical home first tuesdays. Management of hypertensive disorders in pregnancy hind n. Pdf management of hypertensive disorders in pregnancy. Postpartum management of hypertensive disorders of pregnancy. Diagnosis and management of hypertension in pregnancy. Sep 28, 2015 in addition, the guideline includes the management of chronic hypertension in pregnancy, an approach to screening, advice regarding prevention of hypertensive disorders of pregnancy, and discussion of recurrence risks and long term risk to maternal health. Hypertensive disorders of pregnancy are major contributors to prematurity. Diagnosis, evaluation, and management of the hypertensive.
Management of women with hypertensive disorders of pregnancy august 2012 updated march 2014 a. 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. New nice guideline update on hypertension in pregnancy. Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, preeclampsia. Hypertensive pregnancy disorders complicate 6% to 8% of pregnancies and cause significant maternal and fetal morbidity and mortality. Hypertensive disorders of pregnancy journal of obstetric. Background preeclampsia is a leading cause of iatrogenic preterm birth. 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. Nnepqin guideline for the management of hypertensive. Current guidelines differentiate between the treatment of women with acute hypertensive syndromes of pregnancy and. Management of preeclampsia and gestational hypertension 11 6. Aug 25, 2010 this guideline has been updated and replaced by hypertension in pregnancy.
Guidelines for the management of hypertensive disorders of pregnancy article pdf available in australian and new zealand journal of obstetrics and gynaecology 493. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy laura a. In early 2011, as the 62nd president elect of the american college of obstetricians and gyne. Hypertensive disorders affect up to 10% of pregnancies in the united states.
Purpose this document outlines the guideline or procedure details for the indications, contraindications, administration and monitoring of magnesium sulfate sulphate use at the womens. These are the recommendations of a multidisciplinary working party convened by the society. Hypertension is the most common medical problem encountered during pregnancy, complicating 23% of pregnancies. The causes of preeclampsia and the optimal clinical management of the hypertensive disorders of pregnancy remain uncertain. The management of hypertensive disorders of pregnancy. Updates in management of hypertensive disorders of. 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. Guidelines for selecting antihypertensive drug treatment in pregnancy. Abanoub gabra, department of obstetrics and gynecology, assuit university, egypt. Management of gestational hypertension is similar to that of preeclampsia, with expectant monitor ing and labor induction at 37 weeks gestation. Definitions for hypertensive disorders of pregnancy. Magnesium sulphate management of hypertensive disorders of. 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 embrace a variety of definitions as shown below.
This page includes the following topics and synonyms. Lowe sa, brown ma, dekker ga, gatt s, mclintock ck, mcmahon lp, et al. It provides supplementary information regarding guideline development, makes. 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. The quality of evidence reported in these guidelines has been adapted from the. This document is not intended to replace clinical judgment in the care of women with hypertensive disorders in pregnancy. 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. The management of hypertension in pregnancy advances in. This guidance has been updated and replaced by nice guideline ng3. Management of hypertensive disorders in pregnancy an evidence based approach.
Early diagnosis and careful monitoring of patients with preeclampsia is the corner stone in management. 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. Pdf current best practice in the management of hypertensive. Maternity management of hypertensive disorders of pregnancy summaryall nsw public health organisations providing maternity services andor emergency department services must have clinical practice guidelines and protocols for the management of hypertensive disorders of pregnancy based on this policy directive. Somanz guidelines for the management of hypertensive. Beyond 34 weeks, delivery is indicated for women with severe preeclampsia, and those with unstable maternalfetal conditions.
Making decisions using nice guidelines explains how we use words to show the. Executive summary this document reflects emerging clinical and scientific advances on the date issued and is subject to change. Int med senior resident, department of medicine, osmania general hospital physician, princess esra hospital. Hypertensive disorders of pregnancy queensland health. Discuss the treatment of hypertensive disorders of pregnancy. Pdf guidelines for the management of hypertensive disorders. The classification and diagnosis of the hypertensive disorders of pregnancy. 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. Management of hypertensive disorders of pregnancy webinar will begin at 7.
Hypertensive disorders in pregnancy current practice. Regardless of the hypertensive disorder of pregnancy, bps consistently at or 14090 mm hg in clinic or office or. The management of hypertensive disorders of pregnancy 2014 lowe sa, bowyer l, lust k, mcmahon lp, morton m, north ra, paech m. Figure 3 summarizes management of hypertensive disorders in pregnancy associated with severe features. These guidelines are intended for healthcare professionals, particularly. Hypertensive disorders of pregnancy american family physician. 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. Classification of the hypertensive disorders of pregnancy glowm. Eclampsia remain a severe complication of preeclampsia and is associated with increased maternal. Preeclampsia is a risk factor for future cardiovascu. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Welcome to the pregnancy medical home first tuesdays webinar.
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. Classification of hypertensive disorders in pregnancy 5 4. Objectives hypertensive disorders of pregnancy hdp affect one in ten pregnancies and often persist postpartum when complications can occur. Guideline for the management of hypertensive disorders. Current data suggest improved perinatal outcomes with expectant. Elevated blood pressure in pregnancy may represent chronic hypertension occurring before 20 weeks gestation or persisting longer than 12 weeks after delivery, gestational hypertension. Preeclampsia is a potentially serious complication of pregnancy with. Hypertensive disorders of pregnancy hypertension aha journals.
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. Stabilization of maternal status with magnesium sulfate and antihypertensive therapy is recommended. This guideline is an evidence based, practical clinical approach to the management of hypertensive disorders of pregnancy. 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.
These documents are the primary basis for this guideline. 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 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 of pregnancy, pregnancy related hypertension, pregnancy induced hypertension, hypertension induced by pregnancy, gestational hypertensionpreeclampsia, preeclampsia, pih, eph gestosis, preeclampsia. Guideline for the management of hypertensive disorders of.
Management of hypertensive disorders in pregnancy mdedge. The guideline is a partial update of the 2010 nice clinical guideline on hypertension in pregnancy. In the past, severe preeclampsia was treated by timely delivery. Management of hypertensive disorders in pregnancy request pdf. It includes recommendations for women with chronic hypertension who wish to.