> Hypertension in pregnancy – Management of pregnancy with high blood pressure in pregnancy

1.5 Management of pregnancy with pre-eclampsia

1.5.1 Treatment of hypertension

1.5.1.1 Valutaree women with pre-eclampsia at each consultation. The evaluation should be carried out by a health care professional expert in the management of disorders hypertensive pregnancy.

1.5.1.2 Offer women with pre-eclampsia an integrated package of care covering admission to hospital, treatment, measurement of blood pressure, examination for proteinuria and blood as shown in the Table 2

Table 2. management of pregnancy with pre-eclampsia

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

Trattamento

With labetatolo oral as first-line treatment to keep:

* pressione diastolica fra 80-100 mmHg

* systolic pressure less than 150 mmHg

With labetatolo oral as first-line treatment to keep:

* pressione diastolica fra 80-100 mmHg

* systolic pressure less than 150 mmHg

Measuring pressure

at Least 4 times a day

at Least 4 times a day

Più of 4 times per day depending on the clinical circumstances,

Test per proteinuria

do Not repeat quantification of proteinuria

do Not repeat quantification of proteinuria

do Not repeat quantification of proteinuria

Analisi del sangue

Monitor using the following tests twice a week: kidney function, electrolytes, counts in the total blood, transaminases, bilirubin

Monitor using the following tests twice a week: kidney function, electrolytes, counts in the total blood, transaminases, bilirubin

Monitor using the following tests twice a week: kidney function, electrolytes, counts in the total blood, transaminases, bilirubin

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

1.5.2 Programming of the birth

1.5.2.1 Manage pregnancy in women with pre-eclampsia conservatively (that is; not to plan birth day of the baby) until 34 weeks.

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1.5.2.2 The staff at the obstetric consultation should be documented in the notes of the woman of the thresholds, the maternal (biochemical, haematological and clinical) and fetal birth elective before 34 weeks in women with pre-eclampsia.

1.5.2.3 staff obstetric consultation should write a plan for fetal monitoring antenatale during the birth.

1.5.2.4 Offer birth to women with pre-eclampsia before 34 weeks after discussion with neonatal and anaesthetic, and after that has been done a course of corticosteroids if:

    the

  • develops severe hypertension that is refractory to treatment
  • the

  • indications for maternal or fetal develop as specified in the consultation plan.

1.5.2.5 Recommend birth for women who have pre-eclampsia with severe hypertension after 34 weeks when their blood pressure is controlled and è was completed a course of corticosteroids (if appropriate).

1.5.2.6 Offer birth to women who have pre-eclampsia with mild or moderate hypertension from 34 to 36th week depending on the conditions, maternal and fetal, risk factors, and availability; support the neonatal intensive care.

1.5.2.7 Recommend birth within 24-48 hours for women who have pre-eclampsia with hypertension or mild to moderate after the 37th week.

1.5.3 Investigation of postnatal monitoring and treatment (including after the resignation from assistance critical)

blood Pressure

1.5.3.1 In women with pre-eclampsia who have not had treatment in the hypertensive, and have given birth, measure blood pressure:

    the

  • at least four times daily while the woman is hospitalized
  • the

  • at least once between the 3 and the 5 day after birth
  • every other day finché normal if the blood pressure was abnormal on days 3-5.

1.5.3.2 In women with pre-eclampsia who have not had treatment in the hypertensive, and have given birth to, begin treatment with anti-hypertensive if the pressure is 150/100 mmmHg or più high.

1.5.3.3 Ask women with pre-eclampsia who have given birth if they have severe headaches and epigastric pain each time you measured the pressure.

1.5.3.4 In women with pre-eclampsia who have had the treatment anti-hypertensive and have just given birth, measure blood pressure:

    the

  • at least four times daily while the woman is hospitalized
  • the

  • every 1-2 days to weeks after transfer to community care finché, the woman has not finished the treatment and has no hypertension.

1.5.3.5 For women with pre-eclampsia who have had anti-hypertensive, and have given birth to:

    the

  • to continue the treatment anti-hypertensive antenatale
  • consider reducing the treatment an anti-hypertensive if their blood pressure falls below 140/90 mmHg
  • the

  • to reduce the anti-hypertensive if the pressure falls below 130/80 mmHg.

1.5.3.6 If a woman has taken methyldopa to treat pre-eclampsia, stop within 2 days of the birth.

1.5.3.7 Offer women with pre-eclampsia who have given birth transfer to community care if all of the following criteria:

  • there are no symptoms of pre-eclampsia
  • the blood pressure, with or without treatment, is 149/99 mmHg or più low
  • the

  • the results of the blood tests are stable and improving.

1.5.3.8 Write a care plan for women with pre-eclampsia who have given birth and are transferred to community care that includes all of the following:

    the

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

  • frequency of monitoring of pressure
  • the

  • thresholds to reduce or cease the treatment
  • the

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

  • self-monitoring for symptoms.

1.5.3.9 Offer a medical analysis to women who have pre-eclampsia and are still on treatment an anti-hypertensive 2 weeks after transfer to community care.

1.5.3.10 Offer to all the women who have had pre-eclampsia, a medical analysis to the analysis of postnatal (6-8 weeks after the birth).

1.5.3.11 Offer to women who have had pre-eclampsia and who still require anti-hypertensive to the analysis of postnatal (6-8 weeks after the birth) a special evaluation of their hypertension.

Monitoring the hematological and biochemical

1.5.3.12 In women who have pre-eclampsia with mild or moderate hypertension, or after the exit from the assistance criticism:

    the

  • measure platelet count, transaminases and serum creatinine 48-72 hours after birth or discharge from hospital
  • the

  • do not repeat platelet count, transaminases and serum creatinine if results are normal after 48-72 hours.

1.5.3.13 If biochemical indices and hematological are improving but remain under abnormal in women with pre-eclampsia who have given birth, repeat platelet count, transaminases and serum-creatinine as clinically indicated, and to the analysis of postnatal (6-8 weeks after the birth).

1.5.3.14 If biochemical indices and haematological not they are improving in relation to the parameters of pregnancy in women with pre-eclampsia who have given birth, repeat measurements of platelet count, transaminases and serum-creatinine as clinically indicated.

1.5.3.15 In women with pre-eclampsia who have given birth to, conduct a urine test with a swab in reaction to the analysis of postnatal (6-8 weeks after the birth).

1.5.3.16 In women with pre-eclampsia who have given birth and are outputs from the assistance critical level 2 do not measure fluid balance if creatinine is within normal parameters.

1.5.3.17 Offer to women who have had pre-eclampsia and still have proteinuria (1+ or more) to the analysis of postnatal further analysis at 3 months after the birth to evaluate renal function and consider offering them a referral for evaluation for renal specialist.

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