The following forms are described in the recent european guidelines 1 preexisting hypertension. This guideline covers diagnosing and managing hypertension high blood pressure, including preeclampsia, during pregnancy, labour and birth. Ongoing monitoring for increased hypertension and proteinuria, consideration of expectant management or labor. High blood pressure is common during pregnancy, but can also be a serious concern to monitor. High blood pressure, or hypertension, is when this force against your artery walls is too high. Feb 09, 2017 prevalence of hypertension in pregnancy was found to be 6. Hypertension in pregnancy national high blood pressure education program working group on high blood pressure in pregnancy 2000 acog practice bulletin number 33. Pregnancy labetolol first line, nifedipine, methyldopa beta1 selective betablockers possibly safer in patients. There is consensus that introduction of the 2010 nice evidencebased guidelines, together with the findings from the confidential enquiry into maternal deaths. Previous preeclamptic pregnancy chronic htn or chronic renal disease or both history of thrombophilia mutifetal pregnancy in vitro fertilization family history of preeclampsia type i or type ii diabetes mellitus obesity systemic lupus erythematosus advanced maternal age older than 40 years. Hypertensive emergencies in pregnancy courtney olsonchen, md, neil s. Jan 15, 2016 hypertensive disorders affect up to 10% of pregnancies in the united states. In other cases, high blood pressure develops during pregnancy. Despite the scarcity of robust data to direct the drug treatment of hypertension during pregnancy and the puerperium 80, women in the index study were only treated with the commonly recommended.
High blood pressure during pregnancy can occur due to preexisting hypertension, or happen first when. Pregnancy should not be viewed as a body of rigid rules. Jun 12, 2018 hypertension is the most common medical problem encountered during pregnancy, complicating 23% of pregnancies. Hypertension in pregnancy should be defined as an office or inhospital systolic blood pressure once significant proteinuria of preeclampsia has. Blood pressure is the force of your blood pushing against the walls of your arteries as your heart pumps blood. Preeclampsia is a risk factor for future cardiovascu lar disease and metabolic disease in women. Elevated blood pressure in pregnancy may represent chronic hypertension occurring before 20 weeks gestation or persisting longer than 12 weeks after delivery, gestational hypertension. It was classically defined as a triad of hypertension, oedema, and proteinuria, but a more modern definition of preeclampsia concentrates on a gestational elevation of blood pressure together with 0. Ccsap 2018 book 1 medical issues in the icu 10 hypertensive emergencies dissection, acute stroke ischemic and hemorrhagic, and pregnancyassociated severe hypertension preeclampsiaeclampsia and hypertensive emergency in the pregnant. Six percent pregnant women had history of both pregnancy induced hypertension and gestational diabetes figure 5. Primary, or essential, high blood pressure is the most common type of high blood pressure. Classifying hypertension in pregnancy caregivers have been and continue to be confused by the multiple terminologies, some complex and detailed, used to classify the hypertensive disorders of pregnancy.
Management rdless of the hypertensive disorder of pregnancy, re bp requires urgent treatment in a monitored setting when severe 160110 mm hg. Hypertensive disorders of pregnancy are major contributors to prematurity. Gestational hypertension is defined as having a blood pressure greater than 14090 on two separate occasions at least 6 hours apart. Classification of pregnancy induced hypertension according to national high blood pressure education program 2000 and acog20 1.
Hypertension is a condition that develops when your blood pressure is too high. Gestational hypertension can lead to a serious condition called preeclampsia, also referred to as toxemia. Gestational hypertension or pregnancyinduced hypertension pih is the development of new hypertension in a pregnant woman after 20 weeks gestation without the presence of protein in the urine or other signs of preeclampsia. A total of 931 pregnant women were included in the present study. Gestational hypertension or pregnancy induced hypertension pih is the development of new hypertension in a pregnant woman after 20 weeks gestation without the presence of protein in the urine or other signs of preeclampsia. High blood pressure in pregnancy preeclampsia medlineplus. This increase in the amount of blood that needs to be pumped from the heart creates increased stress on the organ and circulatory system.
This includes women with chronic hypertensionwhich may be diagnosed before pregnancy or in the early stages of pregnancy. It also includes advice for women with hypertension who wish to conceive and women who have had a pregnancy complicated by hypertension. Sometimes high blood pressure is present before pregnancy. The following forms are described in the recent european guidelines 1 pre existing hypertension. This document is not intended to replace clinical judgment in the care of women with hypertensive disorders in pregnancy. They recommend that for women with mild gestational hypertension or preeclampsia sbp hypertension in pregnancy and blood pressure measurement. Hypertension is the most common medical problem encountered during pregnancy, complicating 23% of pregnancies. Hypertension in pregnancy is diagnosed either from an absolute rise in blood pressure or from a relative rise above measurements obtained at booking. However, with good blood pressure control, you and your baby are more likely to stay healthy.
Among patients with essential hypertension the problem accelerates late in pregnancy in 2% to 11%. For most people who get this kind of blood pressure, it develops over time as you get older. Hypertensive disorders of pregnancy hypertension aha journals. The clinical practice guideline of the canadian hypertensive. There is no excess protein in the urine or other signs of organ damage. June 22, 2016 scope this guideline provides recommendations on how to diagnose and manage hypertension htn in adults aged. These are the recommendations of a multidisciplinary working party convened by the society of obstetric medicine of australia and new zealand.
For example, the terms toxemia, gestosis, pregnancyinduced hypertension, and preeclamptic toxemia have each been used to. Hypertension in pregnancy european society of cardiology. Hypertensive disorders of pregnancy american family. This protocol should not be used in patients with chf, cad, pregnancy, ckd stage 3 or albuminuria or 300 mgg albumintocreatinine ratio or the equivalent in first morning void. According to nhbpep methyldopa, labetalol, beta blockers other than atenolol, slow release nifedipine, and a diuretic in preexisting hypertension are considered as appropriate treatment. Seligman, md, ms introduction classification of hypertensive disorders in pregnancy there are 4 categories of hypertensive disorders in pregnancy as outlined by the 20 american college of obstetricians and gynecologists acog task force on hyper. Pdf hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and.
This summary covers the diagnosis and management of hypertension during pregnancy, labour, and birth. Gestational hypertension also referred to as pregnancy induced hypertension pih is a condition characterized by high blood pressure during pregnancy. Hypertension during pregnancy introduction leading cause of maternal morbidity and mortality worldwide complicates 510% of pregnancies. Secondary high blood pressure is caused by another medical condition or use of certain medicines. Jnc 8 hypertension guideline algorithm initial drugs of. The somanz guideline for the management of hypertensive disorders of pregnancy 2014 lowe sa, bowyer l, lust k, mcmahon l, morton mr, north ra, paech m. Making decisions using nice guidelines explains how we use words to show the strength or certainty of our recommendations, and has. During pregnancy, womens blood volume increases between 30 and 50 percent compared to its normal amount to nourish the baby. Advise women who take angiotensinconverting enzyme ace inhibitors or angiotensin ii receptor blockers 2 arbs.
High blood pressure in pregnancy has become more common. Jan 26, 2018 hypertension is a condition that develops when your blood pressure is too high. Pregnancyinduced hypertension is also called toxemia or preeclampsia. Women with gestational hypertension have high blood pressure that develops after 20 weeks of pregnancy. High blood pressure can also cause problems during and after delivery. Pregnant women who have hypertension are at a higher risk of stroke and complications during delivery. This includes women with chronic hypertensionwhich may be diagnosed before pregnancy or in the early stages of pregnancy htn in pregnancy. For information on how nice is supporting the nhs and social care, view our new rapid guidelines and evidence. Women with pregnancyinduced hypertension pih are at increased risk for preeclampsia, cesarean delivery, renal dysfunction, and placental abruption.
Responsible for 16% of maternal deaths in developed countries hypertension during pregnancy is a marker for cardiovascular morbidity and mortality later in life. Clinical practice guideline the management of hypertension in pregnancy clinical practice guideline the manangement of hypertension in pregnancy institute of obstetricians and gynaecologists, royal college of physicians of ireland and the clinical strategy and programmes division, health service executive. Diagnosis and management of hypertension in pregnancy. Further care site and management may be determined by the patient, her care provider and the mfm physician. The american college of obstetricians and gynecologists acog recently convened a task force on hypertension in pregnancy and have provided an up to date statement with recommendations on treatment of hypertension in pregnancy. Preeclampsia usually occurs after 20 weeks gestation and is a multisystem disorder. Some women have high blood pressure during pregnancy. High blood pressure, also called hypertension, is very common. Hypertensive disorders of pregnancy american family physician.
Hypertension s gestational htn s transient htn ofdisorders in pregnancy pregnancy s preeclampsia s mild s severe classification of the american college of s eclampsia obstetricians and gynecologists s chronic htn preceding pregnancy s chronic htn with superimposed pregnancy. Severity of hypertension in pregnancy is considered on the basis of the presence of target organ involvement ie, maternal or the fetus itself as well as the actual bp level. Jun 07, 2018 hypertension in pregnancy is defined as an sbp. Hypertension diagnosis and management effective date. It occurs in about 7 to 10 percent of all pregnancies. Within the hypertensive crises, hypertensive emergencies account for only around onefourth of. If you develop high blood pressure when youre pregnant, you have gestational hypertension. Prevalence of hypertension in pregnancy was found to be 6. Diagnosis and management of preeclampsia and eclampsia 2002 joint national committee on prevention, detection, evaluation, and treatment of high blood pressure 2004. Pregnancy induced hypertension and associated factors among.
The authors recommend that women with any highrisk factors for. Pregnancyinduced hypertension pih is a form of high blood pressure in pregnancy. Its common to develop hypertension, or high blood pressure, during pregnancy. Usually it starts after youve been pregnant for about 20 weeks, and it goes away after your baby is born. Despite the differences in guidelines, there appears to be consensus that severe hypertension and nonsevere hypertension with evidence of end. Nov 04, 2012 hypertension s gestational htn s transient htn ofdisorders in pregnancy pregnancy s preeclampsia s mild s severe classification of the american college of s eclampsia obstetricians and gynecologists s chronic htn preceding pregnancy s chronic htn with superimposed pregnancy induced hypertension s superimposed preeclampsia s superimposed eclampsia. Outside the scope of this guideline is the management of secondary causes of htn, accelerated htn, acute htn in emergency.
An international journal of womens cardiovascular health aims to stimulate research in the field of hypertension in pregnancy, disseminate the useful results of such research, and advance education in the field. Another type of high blood pressure is chronic hypertension high blood pressure that is present before pregnancy begins. In the united states, high blood pressure happens in 1. Usually it starts after youve been pregnant for about 20 weeks. Management of hypertension before, during, and after pregnancy. Hypertension in pregnancy is a common condition, affecting about 10% of pregnant women. It should be noted that diagnostic and management strategies that are not recommended specifically for their impact on outcomes of. Diagnosis, evaluation, and management of the hypertensive. In the united states, high blood pressure happens in 1 in every 12 to 17 pregnancies among women ages 20 to 44.
Women should exercise during pregnancy to maintain health, appropriate body weight, and reduce the likeli hood of hypertension. Gestational hypertension also referred to as pregnancyinduced hypertension pih is a condition characterized by high blood pressure during pregnancy gestational hypertension can lead to a serious condition called preeclampsia, also referred to as toxemia. Although hypertensive emergencies can lead to significant morbidity and potentially fatal targetorgan damage, only 1%3% of patients with hypertension will have a hypertensive emergency during their lifetime deshmukh 2011. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Hypertensive disorders in pregnancy eurydice lang, msn, rn reading assignment. If a womans blood pressure is well controlled on an agent prepregnancy she may continue it during. Fact sheets about hypertension and related conditions and behaviors. It aims to improve care during pregnancy, labour and birth for women and their babies.
It usually gets better after you treat that condition or stop. Executive summary this document reflects emerging clinical and scientific advances on the date issued and is subject to change. Hypertension in pregnancy dapinderjit gill ross university ms3 s. Hypertensive disorders during pregnancy are classified into 4 categories, as recommended by the national high blood pressure education program working group on high blood pressure in pregnancy. Seligman, md, ms introduction classification of hypertensive disorders in pregnancy there are 4 categories of hypertensive disorders in pregnancy as outlined by the 20. For example, the terms toxemia, gestosis, pregnancy induced hypertension, and preeclamptic toxemia have each been used to. Simultaneous use of an acei, arb, andor renin inhibitor is not recommended. Acog updates guidelines for gestational htn, preeclampsia. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
New nice guideline update on hypertension in pregnancy rcog. Food and drug administration can help you better understand blood pressure medicines and talk to a health care provider about what is right for you. The convention for the absolute value is a systolic 140 mm hg or a diastolic 90 mm hg. There are different types of high blood pressure in pregnancy. This can put the mother and her baby at risk for problems during the pregnancy. Hypertension during pregnancy affects about 68% of pregnant women. Nice hypertension in pregnancy guideline guidelines. Jan 28, 2020 fact sheets about hypertension and related conditions and behaviors.
1544 854 108 271 443 609 1117 15 1076 393 1136 1490 663 230 878 1425 217 193 230 815 1370 352 1378 1225 631 202 426 910 473 1250 411 1161 681 1238 276 144 609 1431 87 514