hypertension%20in%20pregnancy
HYPERTENSION IN PREGNANCY
Hypertension in pregnancy is defined as an average diastolic blood pressure of ≥90 mmHg, based on at least 2 measurements, ≥4 hours apart or systolic blood pressure of ≥140 mmHg taken at least 6 hours apart.
Diagnosis of severe hypertension is made when blood pressure is ≥160/110 mmHg.
Measurement should be repeated after 15 minutes for confirmation.

Monitoring

For Chronic Hypertension or Gestational Hypertension

Maternal Monitoring
  • In each physician visit, patients should be observed closely for early signs of preeclampsia
  • Antihypertensive treatment should be started if severe hypertension develops before term
  • Women with high-risk chronic hypertension are more likely to have adverse maternal and perinatal complications
    • Perinatal loss and neonatal complications may occur in women with renal insufficiency (serum creatinine >1.4 mg/dL), diabetes mellitus (DM) with vascular involvement, severe collagen vascular disease, cardiomyopathy or coarctation of the aorta
    • Other potential maternal outcomes are congestive heart failure, acute renal failure requiring dialysis, or death
Fetal Monitoring
  • Ultrasound examination of the fetus should be done at 16-20 weeks age of gestation (AOG), repeat ultrasound at 30-32 weeks AOG, and monthly thereafter until term to assess fetal growth
For Preeclampsia/Eclampsia

Maternal Monitoring
  • Purpose is to observe progression of the condition both to prevent maternal complications during delivery and to assess fetal well-being
  • Monitor blood pressure (BP) twice weekly
  • Order lab tests as in diagnosis of preeclampsia weekly: Complete blood count (CBC), platelet count, liver enzymes, lactate dehydrogenase (LDH), uric acid, creatinine
  • Assess for proteinuria
  • Invasive hemodynamic monitoring may be required
    • Monitor fluid volume expansion especially in cases of pulmonary edema, persistent oliguria unresponsive to fluid challenge, intractable severe hypertension and in delivery with epidural anesthesia
Fetal Monitoring
  • Do nonstress test (NST) twice weekly
  • Determine amniotic fluid index (AFI) once or twice weekly
  • Biophysical profile (BPP) weekly may replace one of the twice-weekly NSTs and AFIs
  • Ultrasound examination of the fetus should be done every 2-4 weeks to assess fetal growth

Prevention

  • If pre-pregnancy blood pressure (BP) was normal or unknown, stop antihypertensives 3-4 weeks postpartum
  • Monitor BP at 1- to 2-week interval followed by 3- to 6-month interval for 1 year
  • Start treatment if hypertension recurs
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