> Hypertension in pregnancy – to Reduce the risk of disorder hypertensive in pregnancy

women with chronic hypertension should receive advice and treatment in line with ‘Hypertension: management of hypertension in adults in primary care” (NICE clinical guideline 34), unless do not differ specifically from the recommendations in this guideline.

1.2.1 the Council pre-pregnancy

1.2.1.1 Warn women who take angiotensin converter enzyme (ACE) inhibitors, or blockers of receptors of angiotensin II (ARBs):

    the

  • that there is an increased risk of anormalità congenital if you take these drugs during pregnancy
  • the

  • to evaluate another treatment is an anti-hypertensive with the healthcare professional responsible for managing hypertension if they planned the pregnancy.

1.2.1.2 Stop the treatment hypertensive if they take ACE inhibitors or ARBs if they are pregnant (preferably within two working days from the notification of pregnancy) and offer alternatives.

1.2.1.3 Warn the women taking chlorothiazide:

    the

  • può be an increased risk of anormalità congenital, and complications newborn if you take these drugs during pregnancy
  • the

  • to evaluate another treatment is an anti-hypertensive with the health care worker responsible to manage the hypertension, if they plan a pregnancy.

1.2.1.4 Inform the women that make treatments hypertensive, other ACE inhibitors, ARBs or chlorothiazide that the limited evidence available has not shown an increased risk of congenital malformation with such treatments.

1.2.2. Dieta

1.2.2.1 Encourage women with chronic hypertension to keep down their consumption of dietary sodium, by reducing or substituting sodium salt, becauseé this can reduce the blood pressure.

1.2.3 Treatment of hypertension

1.2.3.1 In pregnant women with chronic hypertension without complications tend to keep the blood pressure più lower than 150/100 mmHg.

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1.2.3.2 do Not offer to pregnant women with chronic hypertension without complications the treatment to lower diastolic blood pressure below 80mmHg.

1.2.3.3 Offer to pregnant women with damage of the organs due to chronic hypertension (for example, kidney disease) treatment with the aim of maintaining the blood pressure più based 140/90 mmHg.

1.2.3.4 Offer to pregnant women with chronic hypertension with a secondary referral to a specialist in disorders hypertensive.

1.2.3.5 Offer women with chronic hypertension the treatment the hypertensive according to the treatment pre-existing, profiles of side effects and teratogenicità.

1.2.4 Consultations antenatali

1.2.4.1 In women with chronic hypertension, you have to schedule consultations antenatali additional based on the individual needs of the woman and the child.

1.2.5 the Programming of birth

1.2.5.1 does Not offer birth to women with chronic hypertension whose blood pressure is più lower than 160/110 mmHg, with or without treatment, hypertensive, before 37 weeks.

1.2.5.2 For women with chronic hypertension whose blood pressure è più lower than 160/110 mmHg after 37 weeks with or without treatment, the hypertensive, the moment of birth and the indications for maternal and fetal for birth should be agreed between the woman and the obstetrician senior.

1.2.5.3 Offer birth to women with hypertension, severe chronic and refractory, after a course of corticosteroids (if required), è was completed.

1.2.6 Investigation of the postnatal, monitoring and treatment

1.2.6.1 In women with chronic hypertension who have given birth, measure blood pressure:

    the

  • daily for the first two days after birth
  • the

  • at least once between the third and fifth day after birth
  • the

  • as clinically indicated if the treatment of the hypertensive is changed after birth.
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1.2.6.2 In women with chronic hypertension who have given birth, aim to keep the blood pressure più low 140/90 mmHg.

1.2.6.3 In women with chronic hypertension who have given birth to:

    the

  • to continue the treatment anti-hypertensive antenatale.
    to analyze the treatment anti-hypertensive long-term 2 weeks after the birth.

1.2.6.4 If a woman has taken methyldopa to treat chronic hypertension during pregnancy, stop within 2 days of birth and restart the treatment an anti-hypertensive that the woman did before planning the pregnancy.

1.2.6.5 Offer women with chronic hypertension a medical analysis to the analysis of postnatal (6-8 weeks after birth) with the support team, pre-pregnancy.

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