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Hypertension in PregnancyAka: Chronic Hypertension in Pregnancy, Gestational Hypertension
- See Also
- Definition
- Chronic Hypertension in pregnancy
- Chronic Hypertension that extends into pregnancy without Preeclampsia
- Gestational Hypertension
- Hypertension in pregnancy with onset beyond 20 weeks gestation and NO Proteinuria
- Chronic Hypertension in pregnancy
- Complications: Pregnancy Related
- Risk Factors: Superimposed Preeclampsia Risk Factors
- Age 35 years or higher
- Antihypertensive needed for Blood Pressure control
- History of prior pregnancy complications
- Preeclampsia
- Untrauterine growth retardation
- Intrauterine Fetal Demise
- Comorbid conditions
- Diabetes Melllitus
- Systemic Lupus Erythematosus
- Chronic cardiopulmonary disease
- Renal disease
- Abnormal labs
- Serum Creatinine >1.0 mg/dl
- Proteinuria >300 mg/24 hours
- Phopholipid Antibody positive
- Monitoring
- Initial evaluation (at time of diagnosis)
- Estimate Fetal Growth
- Estimate amniotic fluid index (AFI)
- Non-Stress Test (NST)
- Biophysical Profile (BPP) if NST not reactive
- Further evaluation if BPP <8
- Repeat Testing
- Ultrasound every 4 weeks starting at 28 weeks gestation
- Other testing as indicated for significant maternal status changes
- Initial evaluation (at time of diagnosis)
- Management
- See PIH Blood Pressure Management
- See Anti-Hypertensive Medications in Pregnancy
- Hypertension therapy during pregnancy does not reduce pregnancy complications
- See antihypertensives below
- Aspirin does not lower Preeclampsia risk
- Low sodium diet shows no benefit
- Minimizing weight gain shows no benefit
- Exercise restriction offers no benefit
- Management: Anti-hypertensives
- Goal: Lower Systolic Blood Pressure to <150/100 (much higher than non-pregnant goal)
- Anti-hypertensives are not indicated for mild to moderate chronic Hypertension in pregnancy
- Treatment of BP <150/100 does not reduce risk to fetus or prevent Preeclampsia
- Antihypertensives benefit mother only (these do not reduce pregnancy complications)
- van Dadelszen (2000) :
- Aggressive lowering of Blood Pressure may result in adverse fetal outcomes
- Severe chronic Hypertension (consistently >150-180/100-110) should be treated
- (2001) Obstet Gynecol 98(1 suppl):177
- Treatment of BP <150/100 does not reduce risk to fetus or prevent Preeclampsia
- Antihypertensive used in pregnancy
- Alpha methyldopa 500 mg PO bid (up to 2 grams bid)
- Labetolol 200 mg PO bid (up to 1200 mg bid)
- Felodipine 5 mg PO daily (up to 20 mg daily)
- Hydrochlorothiazide
- Not usually initiated in pregnancy due to volume depletion
- May be continued if on pre-pregnancy - consult with local expert opinion
- Nifedipine XL 30 mg PO bid (up to 120 mg daily)
- Hydralazine 10 mg PO tid (up to 25 mg tid)
- Precautions: Chronic Hypertension in Pregnancy
- Observe for superimposed Preeclampsia on chronic Hypertension
- High index of suspicion if maked Blood Pressure increase or new onset Proteinuria
- Precautions: Gestational Hypertension
- Preeclampsia will develop in 50% of those with gestational Hypertension onset 24-35 weeks
- Severe gestational Hypertension is associated with worse outcomes than mild PIH
- Treat with same management protocol as Severe Preeclampsia
- Buchbinder (2002) Am J Obstet Gynecol 186:66
- References
Hypertension induced by pregnancy (C0340274) | |
|---|---|
| Definition (MSH) | A condition in pregnant women with elevated systolic (>140 mm Hg) and diastolic (>90 mm Hg) blood pressure on at least two occasions 6 h apart. HYPERTENSION complicates 8-10% of all pregnancies, generally after 20 weeks of gestation. Gestational hypertension can be divided into several broad categories according to the complexity and associated symptoms, such as EDEMA; PROTEINURIA; SEIZURES; abnormalities in BLOOD COAGULATION and liver functions. |
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 642.3 |
| MSH | D046110 |
| English | Gestational Hypertension, GH - Gestational hypertension, Hypertension induced by pregnancy, Hypertension of preg., Hypertension of pregnancy, HYPERTENSION PREGN IND, PIH - Pregnancy-induced hypertension, Pregnancy Associated Hypertension, Pregnancy Induced Hypertension, Pregnancy-induced hypertension |
| Spanish | hipertension gestacional, hipertension inducida por el embarazo |
| Parent Concepts | Hypertensive disease (C0020538), Pregnancy Complications (C0032962), Hypertension induced by pregnancy (C0340274), Hypertension AND/OR vomiting complicating pregnancy childbirth AND/OR puerperium (C1263818), Hypertension without albuminuria AND without edema in the obstetric context (C1288270), Duplicate concept (C1274013) |
| Sources | COSTAR, MSH, MTH, MTHICD9, NCI, OMIM, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
