Management and future risks snigdha reddy and belinda jim pregnancyinduced hypertension is a major cause of maternal and fetal morbidity and mortality. High blood pressure, also called hypertension, is very common. Drug treatment for severe hypertension in pregnancy world health. June 22, 2016 scope this guideline provides recommendations on how to diagnose and manage hypertension htn. Guideline for the management of hypertensive disorders of. Hypertension in pregnancy management of diabetic renal disease prior to conception and during pregnancy is both complex and controversial. Hypertensive disorders of pregnancy american family. This guidance has been updated and replaced by nice guideline ng3. The goal of treatment is to prevent significant cerebrovascular and.
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. A recent report highlighted hypertensive disorders as one of the major causes of pregnancy related maternal deaths in the. Hypertension canadas 2018 guidelines for the management. List the risk factors for hypertension during pregnancy in. Diagnosis and management of gestational hypertension and.
Diagnosis and management of hypertension in pregnancy. In western australia alone, hypertension occurs in 4. Hypertension in pregnancy remains one of the leading causes of maternal deaths with approximately 1 in 100 000 women in the uk dying from complications associated with it. Hypertensive disorders affect up to 10% of pregnancies in the united states. Clinical practice guideline the management of hypertension in pregnancy. Diagnosis and management of gestational hypertension and preeclampsia baha m.
The overall strategy in the treatment of hypertension in pregnancy is to prevent maternal cerebrovascular and cardiac complications, while preserving the uteroplacental and fetal circulation and limiting medication toxicity to the fetus. Systolic hypertension of greater than 180 mmhg is a medical emergency. These guidelines are intended for healthcare professionals. The goal of treatment is to prevent significant cerebrovascular and cardiovascular events in the mother without compromising fetal wellbeing. Management of hypertension before, during, and after pregnancy. Oral regimen management of acute hypertension in pregnancy. The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal.
Similar to the nonpregnant population, hypertension is the most common medical disorder encountered during pregnancy and is estimated to occur in about 68% of pregnancies. However, the diagnosis of hypertension, in pregnancy or otherwise, requires first and foremost an accurate measurement of bp. Hypertensive pregnancy disorders complicate 6% to 8% of pregnancies and cause significant maternal and fetal morbidity and mortality. Hypertension canadas 2018 guidelines for the management of hypertension in pregnancy. Hypertension is usually treated to achieve a blood pressure of below 14090 mmhg to 160100 mmhg. Chronic hypertension is defined as blood pressure exceeding 14090 mm hg before pregnancy or before 20 weeks gestation. It is acknowledged that in many parts of the world, it will not be. Current guidelines differentiate between the treatment of women with acute hypertensive syndromes of pregnancy and. Hypertension in pregnancy is defined as a blood pressure of greater than or equal to 140 mmhg systolic or 90 mmhg diastolic on at least two measurements, ideally separated by a period of rest.
Pdf hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and. When hypertension is first identified during a womans. Some women have high blood pressure during pregnancy. Very low weak in women with severe preeclampsia, a. Report of the american college of obstetricians and gynecologists task force on hypertension in pregnancy. Hypertension is managed using lifestyle modification and antihypertensive medications. The management of hypertension in pregnancy must be individualized, while thorough counseling must be given to the parents concerning maternal health and fetal safety. Feb 09, 2017 prevalence of hypertension in pregnancy was found to be 6. Diagnosis and management of hypertension in pregnancy the bmj. Prevalence of hypertension in pregnancy was found to be 6.
Hypertensive disorders represent major causes of pregnancy related maternal mortality worldwide. Hypertension is the most common medical problem encountered in pregnancy and remains an important cause of maternal, and fetal, morbidity and mortality. Management of chronic hypertension in pregnancy 19, 20, 32, 35, 3841 antihypertensive treatment f etal monitoring decision of delivery indication. Hypertensive disorders of pregnancy leading cause of maternal morbidity accounts for 16. Outside the scope of this guideline is the management of secondary causes of htn, accelerated htn, acute htn in emergency. The management of hypertension in pregnancy sciencedirect.
Management of htn during pregnancy is challenging and it requires. Hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality worldwide, and they are directly responsible for approximately 14% of maternal deaths. Pdf medication for management of pregnancyinduced hypertension. The main objective of the journal is to set a forum for publication, education, and exchange of opinions, and to promote research and publications globally. During pregnancy, chronic hypertension is categorized as. High blood pressure in pregnancy has become more common. Hypertension canadas 2018 guidelines for the management of hypertension in. Maternity management of hypertensive disorders of pregnancy. Aug 08, 2018 chronic hypertension with superimposed preeclampsia. High blood pressure can also cause problems during and after. Management of hypertension in pregnancy in rural areas. The hypertensive disorders of pregnancy cover a spectrum of conditions, of which preeclampsia poses the greatest potential risk and.
It also includes advice for women with hypertension who wish to conceive and women who have had a pregnancy complicated by hypertension. Hypertensive disorders of pregnancy american family physician. In women with hypertensive disorders in pregnancy, abpm has modest prognostic value in predicting adverse outcomes but further research is necessary to define its role in clinical management of hypertensive disorders in pregnancy. Chronic hypertension complicates 35% of pregnancies 4 although this figure may rise, with the trend for women to postpone childbirth into their 30s and 40s. Sibai, md gestational hypertension and preeclampsia are common disorders during pregnancy, with the majority of cases developing at or near term. Making decisions using nice guidelines explains how we use words to show the. It also includes advice for women with hypertension. The causes of preeclampsia and the optimal clinical management of the hypertensive disorders of pregnancy remain uncertain. Hypertension in pregnancy european society of cardiology.
This includes women with chronic hypertensionwhich may be diagnosed before pregnancy or in the early stages of pregnancy hypertension is the most common medical problem encountered in pregnancy and remains an important cause of maternal, and fetal, morbidity and mortality. Jan 15, 2016 hypertensive disorders affect up to 10% of pregnancies in the united states. In the united states, high blood pressure happens in 1 in every 12 to 17 pregnancies among women ages 20 to 44. Reprinted with permission from american college of obstetricians and gynecool gists hy. The diagnosis of chronic hypertension is based on a known history of hypertension pre pregnancy or an elevated blood pressure. Pdf management of chronic hypertension in pregnancy. It aims to improve care during pregnancy, labour and birth for. Importance of providing standardized management of. Guidelines and recommendations for management of hypertension in pregnancy are typically written for implementation in an ideal setting. Approximately 50% of women diagnosed with gestational hypertension between 24 and 35 weeks gestation ultimately develop preeclampsia. This can put the mother and her baby at risk for problems during the pregnancy.
In women with hypertensive disorders in pregnancy, abpm has modest prognostic value in predicting adverse outcomes but further research is necessary. The management of hypertension in pregnancy advances in. Welcome to the pregnancy medical home first tuesdays. June 22, 2016 scope this guideline provides recommendations on how to diagnose and manage hypertension htn in adults aged.
Hypertension in pregnancy is a common condition, affecting about 10% of pregnant women. These same agents may be used for treating gestational or chronic hypertension. This includes women with chronic hypertensionwhich may be diagnosed before pregnancy. Sibai, md gestational hypertension and preeclampsia are common disorders during pregnancy, with the majority. The following forms are described in the recent european guidelines 1. Management of hypertensive disorders of pregnancy webinar will begin at 7. Hypertension diagnosis and management effective date. Vera regitzzagrosek, charite universitaetsmedizin berlin, institute for gender in medicine, ccr, dzhk, partner site berlin, hessische str 34, 10115 berlin, germany, tel.
Classification of hypertensive disorders in pregnancy. Maternity management of hypertensive disorders of pregnancy summaryall nsw public health organisations providing maternity services andor emergency department services must have clinical. It complicates up to 15% of pregnancies and accounts for approximately a quarter of all antenatal admissions. The national institute of health and clinical excellence nice clinical guideline on hypertension in pregnancy. Hypertension in pregnancy is not a single entity1 but comprises.
Hypertensive disorders of pregnancy refer to online version, destroy printed copies after use page 4 of 32 flowchart. Hypertension in pregnancy nhbpep, in which hypertension is defined as blood pressure that is. The purpose of this guideline is to improve the management of hypertension in pregnancy. Evaluation and management of severe hypertension in pregnancy eclampsia algorithm evaluation and treatment of antepartum and postpartum preeclampsia in the emergency department evidence.
This guideline covers diagnosing and managing hypertension high blood pressure, including preeclampsia, during pregnancy, labour and birth. However, with good blood pressure control, you and your baby are more likely to stay healthy. Guideline for the management of hypertensive disorders. Welcome to the pregnancy medical home first tuesdays webinar. Women with secondary hypertension are at a particularly high risk for adverse pregnancy outcomes. Guidelines for selecting antihypertensive drug treatment in pregnancy. Background 5 hypertensive disorders are the leading cause of iatrogenic preterm birth pregnancy medical home care pathway incorporates acog task force 2012 guidance two goals. In nonpregnant individuals, the mainstay of management of diabetic nephropathy is inhibition of the reninangiotensin system with vol. Aspcnmapcna guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension canadas 2018 guidelines for the management of. Hypertension during pregnancy specific disorders cont. Current best practice in the management of hypertensive.
237 1236 1276 579 839 312 196 1199 233 1226 1351 359 25 816 1373 715 791 1418 1175 851 264 887 937 755 598 741 449 562 566