> Hypertension in pregnancy – medical Management of severe hypertension or severe pre-eclampsia in a support environment critical

1.8 medical Management of severe hypertension or severe pre-eclampsia in a support environment critic

1.8.1 Anticonvulsant

1.8.1.1 If a woman in a support environment critic who has severe hypertension or severe pre-eclampsia has or has had formerly an attack eclamptico, give magnesium sulfate intravenously.

1.8.1.2 Assess the needà to give magnesium sulphate intravenously to women with severe pre-eclampsia who are in a support environment critical if the birth is planned within 24 hours.

1.8.1.3 If considering treatment with magnesium sulfate, use the following as traits of severe pre-eclampsia:

    the

  • severe hypertension and proteinuria
    the

  • for mild or moderate hypertension and proteinuria with one or more of the following:
    the

  • symptoms of severe headache
  • the

  • vision problems, such as spots or flashes in front of eyes
  • the

  • severe pain just below the ribs or vomiting
  • the

  • papilloedema
  • the

  • signs of clonus
  • the softness of the liver
  • the

  • syndrome of HELLP
  • the

  • platelet count that falls below 100x10alla9 per liter
  • the

  • abnormal liver enzymes (ALT or AST that grow above 70iu/litre).

1.8.1.4 Use the scheme to Test the Collaborative Eclampsia administration of magnesium sulfate:

    the

  • A loading dose of 4g should be given intravenously over 5 minutes followed by an infusion of 1 g/hour maintained for 24 hours
  • the

  • recurrent attacks should be treated with a further dose of 2-4 g given over 5 minutes.

1.8.1.5 do Not use diazepam, phenytoin or cocktail of lithium as an alternative to magnesium sulphate in women with eclampsia.

1.8.2. Anti-hypertensive

1.8.2.1 Treat women with severe hypertension who are in care critical during pregnancy or after birth immediately with one of the following:

    the

  • labetalol (oral or intravenous)
  • the

  • hydralazine (intravenous)
  • the

  • nifedipine (oral).
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1.8.2.2 In women with severe hypertension who are in the care critique, to monitor the response to treatment:

    the

  • to make sure that their blood pressure to drop
  • the

  • to identify adverse effects for woman and fetus
  • the

  • to change the treatment depending on the response.

1.8.2.3 Consider using up to 50ml of fluid cristalloide before or at the same time of the first dose of hydralazine intravenously in the period antenatale.

1.8.2.4 In women with severe hypertension who are in support of critical, aim to keep systolic blood pressure below 150 mmHg and diastolic between 80 and 100 mmHg.

1.8.3 Corticosteroids for lung maturation of the foetus

1.8.3.1 If the birth is considered likely within 7 days in women with pre-eclampsia:

    the

  • to give two doses of betamethasone 12mg intramuscularly at 24 hours in women between 24 and 34 weeks
  • consider giving two doses of betamethasone 12mg intramuscularly at 24 hours in women between 35 and 36 weeks.

1.8.4 Corticosteroids to manage the syndrome of HELLP

1.8.4.1 do Not use dexamethasone or betamethasone for the treatment of the syndrome of HELLP.

1.8.5 fluid Balance and volume expansion

1.8.5.1 do Not use volume expansion in women with severe pre-eclampsia unless hydralazine is not the anti-hypertensive antenatale.

1.8.5.2 In women with severe pre-eclampsia, limit maintenance fluids to 80ml/hour unless there are other leaks of fluids (for example, haemorrhage).

1.8.6 caesarean section versus induction of childbirth

1.8.6.1 Choose mode of birth for women with severe hypertension, severe pre-eclampsia or eclampsia according to the clinical circumstances and the preferences of the woman.

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1.8.7 Indications for referral to higher levels of care critical

1.8.7.1 Offer women with severe hypertension or severe pre-eclampsia referral to the appropriate environment to support critical using the following criteria:

support Level 3: Severe pre-eclampsia and the needà ventilation
Level 2: to Resign as from level 3 or severe pre-eclampsia with any of the following complications:

    the

  • eclampsia
  • the

  • syndrome of HELLP
  • the

  • haemorrhage
  • the

  • hyperkalemia
  • the

  • severe oliguria
  • the

  • support of coagulation
  • the

  • anti-hypertensive intravenous
  • the

  • starting stabilization of severe hypertension
  • the

  • evidence of failure heart
  • the

  • neurology abnormal

support Level 1:

    the

  • Pre-eclampsia with hypertension or mild to moderate
  • the

  • conservative Management antenatale in the course of severe hypertension, pre-term
  • the Treatment step-down after birth

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