hypertensioninpregnancy acog

8/18/2019 HypertensioninPregnancy ACOG

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IN PREGNANCY HYPERTENSION


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Contents

Task Force on Hypertension in Pregnancy v

Endorsements vii

Foreword ix

Executive Summary 1

Chapter 1: Classification of Hypertensive Disorders 13

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Chapter 5: Management of Preeclampsia and HELLP Syndrome 31

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v

Task Force on Hypertension in Pregnancy

James M. Roberts, MD, Chair

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vi TASK FORCE ON HYPERTENSION IN PREGNANCY

S. Ananth Karumanchi, MD

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Marshall D. Lindheimer, MD

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Michelle Y. Owens, MD, MS

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Baha M. Sibai, MD

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Endorsements

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Foreword

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x FOREWORD

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Executive Summary

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2 EXECUTIVE SUMMARY

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EXECUTIVE SUMMARY 3

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TABLE E-1. Diagnostic Criteria for Preeclampsia

Blood pressure • Greater than or equal to 140 mm Hg systolic or greater than or equal to 90 mm Hgdiastolic on two occasions at least 4 hours apart after 20 weeks of gestation in awoman with a previously normal blood pressure

• Greater than or equal to 160 mm Hg systolic or greater than or equal to 110 mm Hgdiastolic, hypertension can be confirmed within a short interval (minutes) to facilitatetimely antihypertensive therapy

and

Proteinuria • Greater than or equal to 300 mg per 24-hour urine collection (or this amountextrapolated from a timed collection)

or

• Protein/creatinine ratio greater than or equal to 0.3*

• Dipstick reading of 1+ (used only if other quantitative methods not available)

Or in the absence of proteinuria, new-onset hypertension with the new onset of any of the following:

Thrombocytopenia • Platelet count less than 100,000/microliter

Renal insufficiency • Serum creatinine concentrations greater than 1.1 mg/dL or a doubling of the serumcreatinine concentration in the absence of other renal disease

Impaired liver function • Elevated blood concentrations of liver transaminases to twice normal concentration

Pulmonary edema

Cerebral or visualsymptoms

* Each measured as mg/dL.

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Management of Preeclampsia

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TASK FORCE RECOMMENDATIONS

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Chronic Hypertension and

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TASK FORCE RECOMMENDATION

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13

Classification of Hypertensive Disorders

CHAPTER

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14 CLASSIFICATION OF HYPERTENSIVE DISORDERS

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CLASSIFICATION OF HYPERTENSIVE DISORDERS 15

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Establishing the Diagnosis of

Preeclampsia and Eclampsia

CHAPTER

2

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18 ESTABLISHING THE DIAGNOSIS OF PREECLAMPSIA AND ECLAMPSIA

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ESTABLISHING THE DIAGNOSIS OF PREECLAMPSIA AND ECLAMPSIA 19

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Prediction of Preeclampsia

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3

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22 PREDICTION OF PREECLAMPSIA

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PREDICTION OF PREECLAMPSIA 23

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24 PREDICTION OF PREECLAMPSIA

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Prevention of Preeclampsia

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28 PREVENTION OF PREECLAMPSIA


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PREVENTION OF PREECLAMPSIA 29

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30 PREVENTION OF PREECLAMPSIA

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Management of Preeclampsia and

HELLP Syndrome

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32 MANAGEMENT OF PREECLAMPSIA AND HELLP SYNDROME

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MANAGEMENT OF PREECLAMPSIA AND HELLP SYNDROME 33

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Severe Preeclampsia

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Contraindications to continued expectant management

• Eclampsia

• Pulmonary edema

• Disseminated intravascularcoagulation

• Uncontrollable severehypertension

Are there additional expectant complications?

• Greater than or equal to 33 5/7 weeks of gestation

• Persistent symptoms

• HELLP or partial HELLP syndrome

• Fetal growth restriction (less than fifth percentile)

• Severe oligohydramnios

• Reversed end-diastolic flow (umbilical artery Doppler studies)

• Labor or premature rupture of membranes

• Significant renal dysfunction

Expectant management

• Facilities with adequate maternal and neonatal intensivecare resources

• Fetal viability–33 6/7 weeks of gestation

• Inpatient only and stop magnesium sulfate

• Daily maternal–fetal tests

• Vital signs, symptoms, and blood tests

• Oral antihypertensive drugs

• Achievement of 34 0/7 weeks of gestation• New-onset contraindications to expectant management

• Abnormal maternal–fetal test results

• Labor or premature rupture of membranes

• Observe in labor and delivery for first 24–48 hours

• Corticosteroids, magnesium sulfate prophylaxis, and

antihypertensive medications

• Ultrasonography, monitoring of fetal heart rate, symptoms,

and laboratory tests

Delivery once maternalcondition is stable

Delivery

Corticosteroids for fetalmaturation

Delivery after 48 hours

FIGURE 5-2. Management of severe preeclampsia at less than 34 weeks of gestation.

Abbreviation: HELLP, hemolysis, elevated liver enzymes, and low platelet count.

• Nonviable fetus

• Abnormal fetal test results

• Abruptio placentae

• Intrapartum fetal demise

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Yes

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Management of Women With

Prior Preeclampsia

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48 MANAGEMENT OF WOMEN WITH PRIOR PREECLAMPSIA

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MANAGEMENT OF WOMEN WITH PRIOR PREECLAMPSIA 49

Antepartum Management

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Chronic Hypertension in Pregnancy

and Superimposed Preeclampsia

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CHRONIC HYPERTENSION IN PREGNANCY AND SUPERIMPOSED PREECLAMPSIA 53

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71

Later-Life Cardiovascular Disease

in Women With Prior Preeclampsia

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8

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72 LATER-LIFE CARDIOVASCULAR DISEASE IN WOMEN WITH PRIOR PREECLAMPSIA

References

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Patient Education

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74 PATIENT EDUCATION

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PATIENT EDUCATION 75

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76 PATIENT EDUCATION

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PATIENT EDUCATION 77

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State of the Science and

Research Recommendations

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