what treatment is recommened in for hypertensive emergerncy in pregnant women

Further studies are needed before propranolol

, i.v. nitroglycerin, captopril, clonidine, minoxidil, naldolol, atenolol, or metoprolol can be recommended. Until further studies are conducted, hydralazine will continue to be the treatment of choice for hypertensive emergencies of pregnancy. Publication types

Full Answer

How to manage hypertension in pregnancy effectively?

Women can suffer from various types of high blood pressure in pregnancy, some of them being:

• Preeclampsia: A complication in pregnancy that is characterized with very high blood pressure. ...
• Chronic hypertension: Present before conception or during the first 20 weeks of pregnancy.
• Chronic hypertension with superimposed preeclampsia: This condition occurs in pregnant women who are already suffering from chronic blood pressure.

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How do you treat hypertension in pregnancy?

For the pregnant parent:

• Weekly evaluations of your platelet count, serum creatinine, and liver enzyme levels
• Weekly assessment of protein in the urine (indicating preeclampsia)
• Regular blood-pressure checks, either by a doctor or at home (after receiving medical guidance and the proper supplies)

How to treat stress naturally during pregnancy?

– Yoga: Yoga and physical activity are one of the best ways to relieve stress and anxiety during pregnancy. It helps to fight the symptoms of depression and is a preferred form of natural remedy in pregnant women. Prenatal yoga is safe throughout the duration of pregnancy and also helps in easier childbirth. [12]

What hypertension medications can you use during pregnancy?

Medicines to avoid during pregnancy

• Angiotensin converting enzyme inhibitors. Angiotensin converting enzyme (ACE) inhibitors interfere with the body’s production of a chemical that causes the arteries to constrict.
• Diuretics. Diuretics such as furosemide (Lasix) and hydrochlorothiazide (Microzide) should be avoided during pregnancy.
• Propranolol. ...

How can pregnant women manage hypertensive emergency?

Further studies are needed before propranolol, i.v. nitroglycerin, captopril, clonidine, minoxidil, naldolol, atenolol, or metoprolol can be recommended. Until further studies are conducted, hydralazine will continue to be the treatment of choice for hypertensive emergencies of pregnancy.

What drugs can be used in a hypertensive emergency in a pregnant patient?

For emergency treatment in preeclampsia, IV hydralazine, labetalol and oral nifedipine can be used [1]. The ACOG Practice Bulletins also recommend that methyldopa and labetalol are appropriate first-line agents and beta-blockers and angiotensin-converting enzyme inhibitors are not recommended [21, 17].

What is the drug of choice for hypertension in pregnancy?

Methyldopa is a drug of first choice for control of mild to moderate hypertension in pregnancy and is the most widely prescribed antihypertensive for this indication in several countries, including the US and the UK.

What is the first-line treatment for hypertension in pregnancy?

Background: Hydralazine, labetalol, and nifedipine are the recommended first-line treatments for severe hypertension in pregnancy.

Are ACE inhibitors used in pregnancy?

It is well accepted that angiotensin-converting enzyme (ACE) inhibitors are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage. First-trimester use, however, has not been linked to adverse fetal outcomes.

Which antihypertensive drug is contraindicated in pregnancy?

Both labetalol and methyldopa are considered safe for use in pregnant women,12,13 while angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) are contraindicated during all trimesters of pregnancy based on their potential teratogenic and fetotoxic effects,1 though this is ...

Why is labetalol first choice in pregnancy?

High blood pressure in pregnancy can cause complications for mother and baby. Labetalol is a blood pressure medication that is recommended for use in pregnancy as it has been shown to work well to lower blood pressure and it has a licence for use in pregnancy.

Why labetalol is given in pregnancy?

Labetalol can help to control high blood pressure and therefore reduces the risk of pregnancy complications.

Why is hydralazine given during pregnancy?

Hydralazine is used to treat high blood pressure (hypertension). It is also used to control high blood pressure in a mother during pregnancy (pre-eclampsia or eclampsia) or in emergency situations when blood pressure is extremely high (hypertensive crisis).

Abstract

Hypertensive pregnancy disorders complicate 6–8% of pregnancies and cause significant maternal and fetal morbidity and mortality. The goal of treatment is to prevent significant cerebrovascular and cardiovascular events in the mother, without compromising fetal well-being.

Introduction

Hypertensive pregnancy disorders cover a spectrum of conditions, including preeclampsia/eclampsia, gestational hypertension, chronic hypertension, and preeclampsia superimposed on chronic hypertension ( Table 1 ).

Blood Pressure Measurement

Hypertension in pregnancy is defined as a systolic BP ≥ 140 mm Hg and a diastolic BP ≥ 90 mm Hg on two separate measurements at least 4–6 hours apart. However, the diagnosis of hypertension, in pregnancy or otherwise, requires first and foremost an accurate measurement of BP.

Blood Pressure Management in Pregnancy

The NHBPEP Working Group Report on High BP in Pregnancy and the American College of Obstetrics and Gynecology (ACOG) guidelines recommend treatment in preeclampsia when the diastolic BP (DBP) is persistently above 105–110 mm Hg, 1 but there is no official recommendation regarding a systolic BP threshold for treatment.

Chronic Hypertension in Pregnancy

Data from the National Health and Nutrition Examination Survey (1999–2008), indicates that the prevalence of hypertension in women aged 20–44 years is 7.7%, and an estimated 4.9% of women use anti-hypertensive pharmacologic therapy, 19 with the two most common categories of medications being diuretics (47.9%) and angiotension-converting enzyme (ACE) inhibitors (44.0%).

Complications of hypertensive pregnancy

The most significant short term complications of hypertensive pregnancy in the mother are cerebrovascular complications, including cerebral hemorrhage and seizures, renal impairment and cardiovascular complications, such as pulmonary edema ( Table 2 ).

Treatment of hypertensive pregnancy disorders

Lifestyle interventions, such as weight loss and a reduction in salt intake, are of proven benefit in non-pregnant hypertensive patients.

What is gestational hypertension?

Gestational hypertension. Hypertension occurring in the second half of pregnancy in a previously normotensive woman, without significant proteinuria or other features of pre-eclampsia, is termed gestational or pregnancy induced hypertension. It complicates 6–7% of pregnancies7and resolves post partum.

What is the most common medical problem during pregnancy?

Hypertension is the most common medical problem encountered in pregnancy and remains an important cause of maternal, and fetal, morbidity and mortality. It complicates up to 15% of pregnancies and accounts for approximately a quarter of all antenatal admissions. The hypertensive disorders of pregnancy cover a spectrum of conditions, ...

What are the three types of hypertension?

There are three types of hypertensive disorders: chronic hyper tension. gestational hypertension. pre-eclampsia. Chronic hypertension. Chronic hypertension complicates 3–5% of pregnancies4although this figure may rise, with the trend for women to postpone childbirth into their 30s and 40s.

How much is the risk of superimposed pre-eclampsia?

The risk of superimposed pre-eclampsia is 15–26%,8but this risk is influenced by the gestation at which the hypertension develops. When gestational hypertension is diagnosed after 36 weeks of pregnancy, the risk falls to 10%.8With gestational hypertension, blood pressure usually normalises by six weeks post partum. Pre-eclampsia and eclampsia.

What is a day assessment unit?

Depending on the severity of maternal symptoms and clinical findings and on the fetal growth pattern, a woman may be referred to a day assessment unit to permit regular outpatient review, or be admitted. Many women are initially asymptomatic, or present with non-specific signs of malaise.

What is the pathogenesis of pre-eclampsia?

The pathogenesis and manifestations of pre-eclampsia can be considered in a two stage model. The primary stage involves abnormal placentation. In the first trimester, in a healthy pregnancy, the trophoblast invades the uterine decidua and reaches the inner layer of the myometrium.

Is methyldopa safe for pregnancy?

Methyldopa is a centrally acting agent and remains the drug of first choice for treating hypertension in pregnancy. It has been the most frequently assessed antihypertensive in randomised trials and has the longest safety track record.

Why is it important to treat severe hypertension?

Severe hypertension should be treated immediately to prevent maternal end-organ damage. Appropriate antepartum, intrapartum, and postpartum management is important in caring for patients with hypertensive disorders.

Is hypertension a pregnancy condition?

Hypertensive disorders are a major cause of maternal and perinatal morbidity and mortality. Treatment of hypertension decreases the incidence of severe hypertension , but it does not impact rates of preeclampsia or other pregnancy complications. Several antihypertensive medications are commonly used in pregnancy, although there is a lack of randomized controlled trials. Severe hypertension should be treated immediately to prevent maternal end-organ damage. Appropriate antepartum, intrapartum, and postpartum management is important in caring for patients with hypertensive disorders.

What is the purpose of hypertension in pregnancy?

The purpose of treatment of severe hypertension in pregnancy is to decrease maternaland fetal complications. Women with severely increased blood pressure are at risk ofstroke, myocardial infarction, renal failure, uteroplacental insufficiency, placentalabruption, and death.11,33,34Severe hypertension is the only modifiable end-organcomplication of preeclampsia.34The blood pressure target for women with CHTNrequiring antihypertensive therapy is to maintain a SBP of 160 mm Hg or less and aDBP of 105 mm Hg or less, or 160/110 mm Hg or less in GHTN and preeclampsia.1It is important to try to avoid an abrupt decrease in pressure which can lead to poten-tial harmful fetal effects.11Therapy should aim to decrease mean arterial pressure byapproximately 20% to 25% over minutes to hours then further decrease blood pres-sure to less than 160/110 mm Hg over the subsequent hours. The signs and symptomsof hypertensive encephalopathy (headache and confusion) often improve rapidly withtreatment.

How many categories of hypertension are there in pregnancy?

The 4 categories include chronic hypertension(CHTN), preeclampsia, gestational hypertension (GHTN), and CHTN with superim-posed preeclampsia.

What is the SBP of a person with preeclampsia?

Hypertension is defined as an SBP of greater than or equal to 140 mm Hg or DBPgreater than or equal to 90 mm Hg on 2 occasions (4 hours apart). Hypertensionis considered severe with a SBP of 160 mm Hg or greater or a DBP of 110 mm Hgor greater.1,11As mentioned, preeclampsia is diagnosed in the presence of elevatedblood pressure and either proteinuria (300 mg of protein in a 24-h urine collectionor protein to creatinine ratio of 0.3 mg/dL) or severe features as evidence of end-organ damage (Box 1). Severe forms of preeclampsia also include eclampsia andHELLP syndrome. HELLP is an acronym for hemolysis (H), elevated liver enzymes(EL) and low platelets (LP; seeBox 2).3Hypertension may be absent or mild in up to 50% of patients with HELLP syndrome.The differential diagnosis of HELLP includes acute fatty liver of pregnancy, gallbladderdisease, lupus flare, and thrombotic thrombocytopenic purpura/hemolytic uremicsyndrome. HELLP syndrome can be differentiated from these other conditions basedon normal ammonia levels, mild renal insufficiency and anemia, and the presence ofhypertension and proteinuria. A potential complication of HELLP syndrome is thedevelopment of a subcapsular liver hematoma. These patients often have phrenicnerve pain, and the diagnosis can be confirmed with imaging studies like computedtomography or abdominal ultrasonography.3Hypertensive encephalopathy is a type of hypertensive emergency characterized bycerebral edema. This typically occurs in patients with SBP of greater than 220 mm Hgor DBP of greater than 120 mm Hg, although it can occur at lower blood pressures inpregnant women and those with newly increased blood pressures.3,4In hypertensiveencephalopathy, there is a failure of the cerebral arteriolar constriction in response toincreasing blood pressure. The signs and symptoms of hypertensive encephalopathy,including headache, confusion, and nausea, can develop over several days. Papille-dema and retinal hemorrhages are frequently seen with fundoscopic examination inpatients with hypertensive encephalopathy.15 Signs of damage to other organs(eg, cardiac dysfunction or renal failure) may also be present.3Persistent evidenceof neurologic deficits could indicate the presence of a stroke.3

When is induction of labor recommended for hypertensive disorders?

Induction of labor is recommended for hypertensive disorders in pregnancy given theassociated maternal and fetal morbidities in addition to the high risk of progression ofdisease. However, the optimal timing of delivery remains controversial. There havebeen no randomized, controlled trials to guide timing of delivery in women withCHTN. A cohort study of women with CHTN found that delivery at 38 to 39 weeksgestation was optimal for balancing fetal and neonatal risks.35The ACOG endorsesdelivery at 38 to 39 weeks for women with CHTN not requiring medication, 37 to

Is antihypertensive medication good for CHTN?

The benefit of antihypertensive medication in mild-to-moderate CHTN remains uncertainand treatment is not recommended for persistent CHTN with a SBP of less than 160 mmHg and a DBP of less than 105 mm Hg.1,16Likewise, antihypertensive medication is not