ACOG task force: hypertension in pregnancy

Question 1

Define gestational hypertension.

Chronic hypertension.

Superimposed preeclampsia.

Answer 1

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

Question 2

How is proteinuria defined?

Answer 2

300 mg or more in 24 hour urine collection
Urine protein/creatinine ratio of at least 0.3
Urine dipstick of 1+

Question 2

What can be recommended for preeclampsia prevention?

Answer 2

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.

Question 3

What features indicate severe preeclampsia?

Answer 3

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

Question 4

What monitoring is recommended for women with gestational hypertension or non-severe preeclampsia?

Answer 4

Daily assessment of maternal symptoms and fetal movement
Twice weekly blood pressure
Weekly platelet count and liver enzymes

Question 5

For women with gestational hypertension, what is recommended for home versus office monitoring?

Answer 5

At least one office BP with proteinuria assessment. Additional weekly measurement can be at home or in the office.

Question 6

When should antihypertensive medicines be given to mild gestational hypertensives or preeclamptics?

Answer 6

They should not if systolic BP is less than 160 or diastolic BP is less than 110

Question 7

What is recommended regarding bedrest?

Answer 7

Strict bedrest should not be prescribed

Question 8

What imaging is indicated for non-severe preeclampsia?

Answer 8

Ultrasound for fetal growth and antenatal testing. Umbilical artery Dopplers if fetal growth is restricted.

Question 9

When is delivery recommended for women with mild gestational hypertension or nonsevere preeclampsia?

Answer 9

37 0/7 weeks gestation

Question 10

When is delivery recommended for severe preeclampsia or HELLP syndrome?

Answer 10

34 0/7 weeks

Question 11

Should magnesium be given for non-severe preeclampsia?

Answer 11

No

Question 12

What blood pressure threshold necessitates antihypertensive therapy for women with preeclampsia?

Answer 12

Sustained systolic BP of 160 or diastolic BP of 110

Question 14

What medication is indicated for severe preeclampsia or eclampsia?

Should this be continued during cesarean section?

Answer 14

Magnesium sulfate

Yes

Question 14

What is recommended for severe preeclampsia or HELLP syndrome prior to fetal viability?

Answer 14

Delivery after maternal stabilization. Expectant management is not recommended.

Question 15

With severe preeclampsia prior to 33 6/7 weeks, what signs warrant immediate delivery (i.e., are not safe to continue expectant management)?

Answer 15

Uncontrollable severe hypertension
Eclampsia
Pulmonary edema
Placental abruption
DIC
Evidence of nonreassuring fetal status
Intrapartum fetal demise

Question 17

Should invasive hemodynamic monitoring be routinely used for severe preeclampsia?

Answer 17

No

Question 18

What postpartum monitoring is recommended in women with gestational hypertension, preeclampsia, or superimposed preeclampsia?

Answer 18

Inpatient blood pressure monitoring for at least 72 hours and again 7-10 days after delivery or earlier in women with symptoms

Question 19

For pregnant women with chronic hypertension what blood-pressure threshold necessitates antihypertensive therapy?

What is the target range?

Answer 19

160 systolic or 105 diastolic

120-160 systolic and 80-105 diastolic

Question 19

What blood pressure threshold necessitates postpartum antihypertensive therapy?

Answer 19

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.

Question 20

What is recommended for monitoring of chronic hypertensive?

How should suspected whitecoat hypertension be evaluated?

Answer 20

Home blood pressure monitoring

Ambulatory blood-pressure monitoring before initiation antihypertensives