> Hypertension in pregnancy – Management of pregnancy with pre-eclampsia

1.6 fetal Monitoring

1.6.1 chronic Hypertension

1.6.1.1 for women with chronic hypertension, evaluation of fetal growth with ultrasound, and the volume of the amniotic fluid and umbilical artery doppler velocimetry between 28 and 30 weeks and between 32 and 34 weeks. If the results are normal do not repeat at more than 34 weeks, unless otherwise clinically indicated.

1.6.1.2 In women with chronic hypertension, do cardiotografia only if the activityà fetal is abnormal.

1.6.2 Hypertension mild or moderate

1.6.2.1 In women with hypertension, gestational mild or moderate, perform assessments of fetal growth with ultrasound, and the volume of the amniotic fluid and umbilical artery doppler velocimetry if diagnosis is confirmed at less than 34 weeks. If the results are normal do not repeat at more than 34 weeks, unless otherwise clinically indicated.

1.6.2.2 In women with hypertension in pregnancy have mild to moderate, do not perform assessments of fetal growth with ultrasound, and the volume of the amniotic fluid and umbilical artery doppler velocimetry if diagnosis is confirmed after 34 weeks, unless otherwise clinically indicated.

1.6.2.3 In women with hypertension in pregnancy have mild to moderate back cardiotografia only if the activityà fetal is abnormal.

1.6.3 Severe hypertension in pregnancy or pre-eclampsia

1.6.3.1 Perform cardiotocography at diagnosis of severe hypertension in pregnancy or pre-eclampsia.

1.6.3.2 If è scheduled for conservative management of severe hypertension in pregnancy or pre-eclampsia, perform all the following tests at diagnosis:

    the

  • assessment ultrasound fetal growth and volume of amniotic fluid
  • the

  • umbilical artery doppler velocimetry.

1.6.3.3 If the results of all monitoring fetal are normal in women with severe hypertension in pregnancy or pre-eclampsia, not to repeat routine the cardiotocograph più than once a week.

1.6.3.4 In women with severe hypertension in pregnancy or pre-eclampsia, repeat cardiotocography if any of the following:

    the woman reports a change in fetal movement

    the

  • vaginal bleeding
  • the

  • abdominal pain
  • the

  • deterioration of the conditions of the mother.

1.6.3.5 In women with severe hypertension in pregnancy or pre-eclampsia not to repeat routine assessment ultrasound fetal growth and fluid volume amniotic fluid or umbilical artery doppler velocimetry more than every two weeks.

1.6.3.6 If the results of any fetal monitoring in women with severe hypertension in pregnancy or pre-eclampsia are abnormal, tell a obstetric consultant.

1.6.3.7 For women with severe hypertension in pregnancy or pre-eclampsia, write a care plan that includes all of the following actions:

  • scheduling and nature of future fetal monitoring
  • the

  • signs of a fetus for birth and if and when they need to be given corticosteroids
  • the

  • when they should take place discussions with the paediatricians, neonatal, and obstetric anesthesiologists and what decisions should be taken.

1.6.4. Women at high risk of pre-eclampsia

1.6.4.1 Carry out ultrasound assessment of growth, volume of amniotic fluid and umbilical artery doppler velocimetry starting between 28 and 30 weeks (or at least two weeks before the previous età gestational start if before 28 weeks) and repeating 4 weeks later in women with previous:

    the

  • severe pre-eclampsia
  • the

  • pre-eclampsia, which had as its necessary consequence the birth before 34 weeks
  • the

  • pre-eclampsia with a baby whose birth weight was less than the tenth centile
  • the

  • intrauterine death
  • the

  • detachment of the placenta

1.6.4.2 In women who are at high risk of pre-eclampsia (see 1.1.2.2) carry out cardiotocography only if the activityà fetal is abnormal.

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