Population: Pregnant and postpartum women with gestational hypertension or preeclampsia.

Organization

ACOG 2020

Recommendations

–Initiate low-dose (81 mg/d) aspirin for preeclampsia prophylaxis, between 12 and 28 wk of gestation (ideally before 16 wk of gestation) and continue until delivery in:

• Women with any high-risk factors for preeclampsia (previous pregnancy with preeclampsia, multifetal gestation, renal disease, autoimmune disease, type 1 or type 2 diabetes mellitus, and chronic hypertension).

• Women with more than one of the moderate-risk factors (first pregnancy, maternal age of 35 y or older, a body mass index of >30, family history of preeclampsia, sociodemographic characteristics, and personal history factors).

–Initiate antihypertensive treatment for acute-onset severe hypertension (SBP ≥160 or DBP ≥110 mmHg) that is confirmed as persistent (15 min or more). Antihypertensive options included hydralazine, labetalol, nifedipine.

–Induce labor at 37-0/7 wk of gestation (or beyond upon diagnosis).

–Proceed toward delivery at 34-0/7 wk of gestation or beyond when gestational hypertension or preeclampsia with severe features is diagnosed.

–Magnesium sulfate should be used for seizure prophylaxis in women with gestational hypertension and preeclampsia with severe features.

–Use nonsteroidal anti-inflammatory medications preferentially over opioid analgesics in postpartum patients, even if on magnesium.

Source

–ACOG. Practice Bulletin No. 222. Gestational Hypertension and Preeclampsia. 2020.