03/06/2025
Hypertension in pregnancy ( ch hypertension , gestational HTN , Preeclampsia ) ... 8 short notes
1- More than 140/90 >>start treatment ... 135/85 or less is the target .....persistent 160/110 or above is the threshold for admisssion or consideration of early delivery ( before 37 week ) ..
2- Offer aspirin 75-150 mg daily for all of these patients from 12th week and throughout pregnancy . offer it also for next pregnancies .
3- Labetalol is the 1st option anti HTN , nefidipine is next , and methyldopa is 3rd ... BBs like metoprolol may be added if needed ...lasix not needed unless pulmonary edema or heart failure ..ACEIs , ARBs , and thiazide diuretics must be avoided and stopped if used before pregnancy .
4- Always stop methydopa within 2 days of labour if used during pregnancy and offer an alternative ... Captopril and enalapril may be used now during breast feeding if needed . ARBs and other ACEIs are still contraindicated .
5- 30 mg/mmol and above is the threshold for significant protieinuria ..8 mg/mmol and above is the threshold for significant albuminuria ( for preeclampsia diagnosis ) ..24 h urine is not generally recommended . You may offer Placental Growth Factor to rule out preeclampsia if suspected .
6-Always consider admssion of all patients with preeclmpsia or geatational hypertension in case of any concern about maternal ( HELLP , RENAL , CARDIAC , OR sustained BP 160/110 or above ) or fetal health .
7-IV labetalol , IV hydralazine or oral nefidipine ( not sublingual ) may be used in critical care setting in patients with severe preecalmpsia or eclampsia.
8- Magnesium dose in case of severe preclampsia or eclampsia ..4 gram bolus over 10 minutes and 1 gram /hour infusion for 24 hours or for 24 hours after the last fit .Repeat bolus if repeated fit . Check neonatal caclium and magnesium if used for more than 5 days .
