ACOG task force: hypertension in pregnancy Flashcards
Define gestational hypertension.
Chronic hypertension.
Superimposed preeclampsia.
Blood pressure elevation after 20 weeks of gestation in the absence of proteinuria or systemic findings
Hypertension that predates pregnancy
Chronic hypertension associated with preeclampsia
How is proteinuria defined?
300 mg or more in 24 hour urine collection
Urine protein/creatinine ratio of at least 0.3
Urine dipstick of 1+
What can be recommended for preeclampsia prevention?
For women with a medical history of early-onset preeclampsia and preterm delivery at less than 34 0/7 weeks or preeclampsia in more than one prior pregnancy, low-dose aspirin beginning in the late first trimester is suggested.
What features indicate severe preeclampsia?
Systolic BP of 160 or higher or diastolic BP of 110 or higher on two occasions at least 4 hours apart
Thrombocytopenia less than 100,000
Impaired liver function of twice normal levels or severe right upper quadrant or epigastric pain
Renal insufficiency with creatinine greater than 1.1 or doubling of baseline
Pulmonary edema
New-onset cerebral or visual disturbances
What monitoring is recommended for women with gestational hypertension or non-severe preeclampsia?
Daily assessment of maternal symptoms and fetal movement
Twice weekly blood pressure
Weekly platelet count and liver enzymes
For women with gestational hypertension, what is recommended for home versus office monitoring?
At least one office BP with proteinuria assessment. Additional weekly measurement can be at home or in the office.
When should antihypertensive medicines be given to mild gestational hypertensives or preeclamptics?
They should not if systolic BP is less than 160 or diastolic BP is less than 110
What is recommended regarding bedrest?
Strict bedrest should not be prescribed
What imaging is indicated for non-severe preeclampsia?
Ultrasound for fetal growth and antenatal testing. Umbilical artery Dopplers if fetal growth is restricted.
When is delivery recommended for women with mild gestational hypertension or nonsevere preeclampsia?
37 0/7 weeks gestation
When is delivery recommended for severe preeclampsia or HELLP syndrome?
34 0/7 weeks
Should magnesium be given for non-severe preeclampsia?
No
What blood pressure threshold necessitates antihypertensive therapy for women with preeclampsia?
Sustained systolic BP of 160 or diastolic BP of 110
What medication is indicated for severe preeclampsia or eclampsia?
Should this be continued during cesarean section?
Magnesium sulfate
Yes
What is recommended for severe preeclampsia or HELLP syndrome prior to fetal viability?
Delivery after maternal stabilization. Expectant management is not recommended.
With severe preeclampsia prior to 33 6/7 weeks, what signs warrant immediate delivery (i.e., are not safe to continue expectant management)?
Uncontrollable severe hypertension Eclampsia Pulmonary edema Placental abruption DIC Evidence of nonreassuring fetal status Intrapartum fetal demise
Should invasive hemodynamic monitoring be routinely used for severe preeclampsia?
No
What postpartum monitoring is recommended in women with gestational hypertension, preeclampsia, or superimposed preeclampsia?
Inpatient blood pressure monitoring for at least 72 hours and again 7-10 days after delivery or earlier in women with symptoms
For pregnant women with chronic hypertension what blood-pressure threshold necessitates antihypertensive therapy?
What is the target range?
160 systolic or 105 diastolic
120-160 systolic and 80-105 diastolic
What blood pressure threshold necessitates postpartum antihypertensive therapy?
150 systolic or 100 diastolic on at least two occasions at least 4-6 hours apart. Persistent systolic BP 160 or diastolic of 110 should be treated within one hour.
What is recommended for monitoring of chronic hypertensive?
How should suspected whitecoat hypertension be evaluated?
Home blood pressure monitoring
Ambulatory blood-pressure monitoring before initiation antihypertensives
