Management of Hypertension and slight to moderate preecalmpsia

Management of Hypertension and
slight to moderate preecalmpsia

Department of Obstetrics and Gynaecology

Se also
Hypertension
Treatment of Preexcisting Hypertension
Hypertension and sligth to moderate preeclamsia
Treatment of Serverhypertension
Treatment of Eclampsia
Drug

NOTE: MILD TO MODERATE HYPERTENSION OR PROTEINURIA ON THEIR OWN DO NOT IMPLY ANY RISK TO THE MOTHER; THEY ARE MERELY MARKERS OF THE DISEASE NOT NECESSARILY AN INDICATION FOR INTERVENTION.

Women with hypertension and mild preeclampsia may be managed as

an outpatient. If diastolic blood pressure = 100, Proteinuria < 1.5 gm/24 hr (= 2+) and no subjective symptoms, and only slight effect on biochemical test.

Blood pressure and urinalysis twice weekly.

Biochemical test weekly (serum urea, creatinine, uric acid hemoglobin platelet, liver function test).

Test of fetal well being with Doppler, amniotic fluid index and eventually CTG weekly Biometry of the fetus every second week

Timing of Delivery: Slight to moderate preeclampsia Induction at 37-38 weeks or consider induction at term.

Chronical hypertension induction at term

Antihypertensive Treatment:
Antihypertensive drug treatment is not usually indicated for women with nonproteinuric gestational hypertension.
However, a diastolic BP > 105 mmHg represents an appropriate level at which to initiate anti-hypertensive therapy as protection against intracerebral hemorrhage.
A lower threshold may be considered where the disease has arisen at < 28 gestation.

On those rare occasions when an antihypertensive agent is indicated for mild gestational hypertension the choic of drug should be governed by the clinician's experience and the woman's preference. Appropriate first-line choices include the alpha agonist, methyldopa or the beta blocker, labetalol. There is little good evidence that one antihypertensive is better than another.

ANTIHYPERTENSIVE TREATMENT (see Drugs)