> Hypertension in pregnancy – Evaluation of proteinuria in hypertensive disorders of pregnancy

1.4 Management of pregnancy with high blood pressure in pregnancy

1.4.1.1 In women with hypertension in pregnancy a full evaluation should be done in an environment of secondary care by a professional healthcare expert in the management of disorders hypertensive.

1.4.1.2 In women with hypertension in pregnancy, keep in mind the following risk factors that require further evaluation, and control:

    the

  • nulliparità
  • the

  • età of 40 years or moreù
  • the range of pregnancy of more than 10 years
  • the

  • family history of pre-eclampsia
  • the

  • multiple pregnancy
  • the

  • BMI of 35kg/m2 or moreù
  • the

  • età the gestation at presentation
  • the

  • prior history of pre-eclampsia or high blood pressure in pregnancy
  • the

  • vascular disease, pre-existing
  • the

  • kidney disease pre-existing

1.4.1.3 Offer women with gestational hypertension an integrated package of care covering admission to hospital, treatment, measurement of blood pressure, testing for proteinuria and blood tests as indicated in Table 1

Table 1. management of pregnancy with high blood pressure in pregnancy

Degree of hypertension

Lieve ipertensione

(140/90 to 149/99 mmHg)

Moderata ipertensione

(150/100 to 159/109 mmHg)

Grave ipertensione

(160/110 mmHg or higher)

hospital

Sì (finché la pressione non è a 159/109 mmHg o più bassa)

Trattare

With labetatolo oral as first-line treatment to keep:

    the

  • diastolic blood pressure between 80–100 mm hg
  • the

  • systolic blood pressure less than 150 mmHg

With labetatolo oral as first-line treatment to keep:

    the

  • diastolic blood pressure between 80–100 mm hg
  • the

  • systolic blood pressure less than 150 mmHg

Measure blood pressure

più than once a week

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Ameno twice a week

at Least four times a day

Test per proteinuria

At each visit using the instrument reagent of reading smear or index protein-to-urinary creatinine

At each visit using the instrument reagent of reading smear or index protein-to-urinary creatinine

Daily using the instrument reagent of reading smear or index protein-to-urinary creatinine

Analisi del sangue

Only those for assistance antenatale routine

Test kidney function, electrolytes, counts, complete blood, liver transaminases, bilirubin,

do Not do more blood tests if not c’è roteinuria in the visie following

initial Test and then monitor weekly:

    the

  • , renal function, electrolytes, counts, complete blood, liver transaminases, bilirubin

1.4.1.4 Provide women with high blood pressure during pregnancy treatment hypertension different from the labetalol only after considering the profiles of side effects for the woman, the fetus and the newborn. The alternatives include methyldopa and nifedipine.

1.4.1. 5 In women receiving external assistance for severe hypertension in pregnancy, after that it has been effectively controlled in hospital, measure blood pressure and test urine twice weekly and do weekly tests of the blood.

1.4.1.6 In women with mild hypertension that occurs before 32 weeks or at high risk of pre-eclampsia measure blood pressure and test urine twice a week.

1.4.1.7 Not offer bed rest in hospital as a treatment for hypertension in pregnancy.

1.4.2 Programming of the birth

1.4.2.1 do Not offer birth before 37 weeks to women with high blood pressure in pregnancy the blood pressure è più lower than 160/110 mmHg, with or without anti-hypertensive.

1.4.2.2 For women with high blood pressure in pregnancy the blood pressure is lower than 160/110 mmHg after 37 weeks, with or without treatment; anti-hypertensive, the programming of birth, and the indications for maternal and fetal for birth should be agreed between the woman and the obstetrician senior.

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

1.4.3 Investigation of postnatal monitoring and treatment

1.4.3.1 In women with hypertension in pregnancy 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.

1.4.3.2 In women with hypertension in pregnancy who have given birth to:

    the

  • continue the use of anti-hypertensive antenatale
  • consider reducing the treatment an anti-hypertensive if the pressure falls below 140/90 mmHg
  • the

  • reduce the treatment hypertensive if the blood pressure drops below 30/80 mmhg

1.4.3.3 If a woman has taken methyldopa to treat chronic hypertension during pregnancy, stop within 2 days of the birth.

1.4.3.4 women with hypertension in pregnancy who have not had anti-hypertensive, and have given birth to, begin treatment with anti-hypertensive if their blood pressure è più high of 149/99 mmHg.

1.4.3.5 Write a care plan for women with high blood pressure in pregnancy, who have given birth and are transferred to the territorial assistance, including all of the following:

    the

  • who will giveà follow-up care, including medical analysis if necessary
  • the

  • as often as needed for blood pressure monitoring
  • the

  • thresholds to reduce or stop the treatment
  • the

  • indications for referral to primary care for the analysis of blood pressure

1.4.3.6 Offer a medical analysis to women who have had hypertension in pregnancy and remain in treatment an anti-hypertensive 2 weeks after transfer to community care.

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1.4.3.7 Offer to women who have had high blood pressure during a medical analysis to the analysis of postnatal (6-8 weeks after the birth).

1.4.3.8 Offer to women who have had hypertension in pregnancy and that still need treatment with anti-hypertensive to the analysis of postnatal (6-8 weeks after the birth) a special evaluation of their hypertension.

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