Population: Pregnant women with hypertension diagnosed or present before pregnancy or before 20 wk of gestation.
Organization
ACOG 2019
Recommendations
–Obtain baseline evaluation of LFTs, serum creatinine, serum electrolytes, BUN, CBC, spot urine protein/creatinine ratio or 24-h urine for total protein and creatinine. Consider ECG for women with longstanding hypertension (HTN >4-y duration or age >30 y).
–In cases of diagnostic uncertainty between chronic HTN and superimposed preeclampsia, admit patient for inpatient surveillance with assessment of hematocrit, platelets, creatinine, LFTs, and new-onset proteinuria.
–Initiate low-dose aspirin (81 mg) between 12 and 28 wk of gestation and continue through delivery.
–Initiate antihypertensive medications when SBP >160 mmHg or DBP >110 mmHg.
–For long-term treatment of pregnant women requiring antihypertension medications, use labetalol and nifedipine as first line.
–Advise delivery according to Table 29–4.
TABLE 29–4 TIMING OF DELIVERY IN PREGNANT PATIENTS WITH CHRONIC HYPERTENSION
Practice Pearls
• Risks of chronic hypertension in pregnancy include maternal death, stroke, pulmonary edema, renal insufficiency/failure, myocardial infarction, preeclampsia, placental abruption, GDM, postpartum hemorrhage, and cesarean delivery.
• Risks of chronic hypertension in pregnancy also include stillbirth/perinatal death, growth restriction, preterm birth, and congenital anomalies.
Source
–Obstet Gynecol. 2019;133(1):e26-e50.