Hypertensive Disorders in Pregnancy: TREE EBOOK

Hypertensive Disorders in Pregnancy

guidline summary

New York State Department of Health

May 2013

Contents
1. Background 5
Introduction 5
Purpose 5
Process 6
2. Definitions and stratification of hypertension in pregnancy 7
a. Hypertension 7
b. Severe hypertension 8
3. Blood pressure measurement technique 9
4. Classification of Hypertensive Disorders in Pregnancy (HDP) 10
a. Recommendation for classification 10
b. Chronic (preexisting) hypertension 10
c. Gestational Hypertension 11
d. Preeclampsia and chronic (preexisting) hypertension with superimposed preeclampsia 11
e. Significant proteinuria in pregnancy 13
f. Severe preeclampsia 14
g. Eclampsia 14
h. HELLP syndrome 15
5. Assessment of HDP 15
a. Assessment of risk for preeclampsia 15
b. Assessment for presence/absence of preeclampsia 16
c. Assessment of proteinuria 16
d. Other assessments of women at risk for preeclampsia 18
e. Fetal testing for women at risk for preeclampsia 19
6. Risk reduction for preeclampsia and other complications of HDP 19
a. Aspirin 19
b. Other pharmaceuticals 20
c. Dietary calcium supplementation 20
d. Other dietary supplements 21
e. Anticipatory guidance 21
f. Diet/lifestyle 22
g. Referrals for at risk 23
7. Ambulatory care of HDP 23
a. Preconception/initial visit counseling and evaluation 23
b. Diet 24
c. Lifestyle 25
d. Blood pressure threshold and targets for treatment 25
e. Antihypertensive agents for non-acute blood pressure management 27
f. Maternal surveillance: blood pressure monitoring 29
g. Maternal surveillance: laboratory testing 30
h. Fetal surveillance: tests of fetal well being 30
i. Frequency of fetal testing and monitoring 32
j. Referrals/consultations 32

8. Inpatient prenatal care of HDP-severe hypertension and preeclampsia 33
a. Indications for inpatient care 33
b. Critical care 33
c. Communications 34
d. Bedrest 34
e. Acute hypertension management 34
f. Inpatient maternal surveillance 37
g. Invasive hemodynamic monitoring 38
h. Fetal surveillance 38
i. Delivery timing/expectant management 38
j. Antenatal steroids 39
9. Inpatient care specific to preeclampsia 39
a. Severity classification 39
b. Seizure prophylaxis 40
c. Thromboprophylaxis 40
d. Referral/consultation 41
10. Eclampsia/HELLP syndrome 41
a. Management of seizures in eclampsia 41
b. Delivery timing eclampsia 42
c. Transfusion for HELLP syndrome 42
d. Other therapy for HELLP syndrome 42
11. Delivery-intrapartum care for women with HDP 43
a. Mode of delivery 43
b. Intrapartum 43
c. Anesthesia concerns 43
d. Analgesia 44
e. Fluid balance 44
12. Postpartum and follow-up 45
a. Postpartum evaluation/surveillance 45
b. Postpartum antihypertensive therapy 46
c. Follow up review/testing 47
d. Risk communication/lifestyle counseling 47
13. Continuous Quality Improvement 48
Main References 50
Endnotes 51
Acknowledgements 53

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