Gestational Hypertension Update

ACOG issued a report on Hypertension in Pregnancy in November 2013. Key points:

Proteinuria is no longer required for a diagnosis of preeclampsia – It can be diagnosed if mom has high blood pressure (gestational or chronic hypertension) plus

  • lowered platelets
  • impaired liver function
  • renal insufficiency
  • pulmonary edema
  • new onset of severe headaches or vision disturbances

Women with a history of early onset preeclampsia and preterm delivery may benefit from daily low-dose aspirin. None of these are recommended to reduce hypertension: low salt intake or vitamin C or E.

Mild gestational hypertension (BP 140/90) and mild preeclampsia is treated with: daily kick counts, twice-weekly blood pressure checks (at home or clinic), weekly blood tests and possibly fetal monitoring. (Note: not hypertensive medication.) Bed rest is not recommended, though some caregivers may recommend reduced activity and reduced stress. Ultrasounds may be done to assess fetal growth, and if IUGR is detected,more testing may be done.

Delivery at 37 weeks is recommended for all women with hypertension.

For severe cases (BP 160/110), she’ll be hospitalized and given hypertensives plus magnesium sulfate to reduce risk of seizures.

If baby is past 34 weeks, they will deliver baby as soon as she is stabilized.

If baby is under 34 weeks, she will be transferred to a hospital with a NICU, given corticosteroids to prepare baby for birth, and then deliver as soon as mom is stable.

Other indications for delivery, even before 34 weeks are: very low platelets, liver enzymes twice the normal value, increasing renal dysfunction, fetal growth restriction (under 5th percentile), very low amniotic fluid (AFI <5 cm).

For women with preeclampsia, cesarean need not be the presumed mode of delivery. Mode of delivery should be determined by gestational age, fetal presentation, cervical status, and maternal and fetal conditions.

Women who continue to have high blood pressure more than 24 hours after birth should avoid non-steroidal anti-inflammatories (e.g. ibuprofen) for pain relief.

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