H T TOPICS IN

Gestational Hypertension and Preeclampsia

H
ypertensive disorders of preg-
nancy continue to be a major
Overview of Management Recommendations
contributor to maternal and Diagnosis Management Recommendations
perinatal morbidity and mortality. A Gestational • Antenatal testing 1–2 times weekly with weekly amni-
summary of the American College of hypertension otic fluid volume assessment
Obstetricians and Gynecologists • Fetal growth assessment via ultrasound every 3–4 weeks
Preeclampsia
(ACOG, 2019) updated guidelines • Birth at 37 0/7 weeks
without severe
for diagnosis and management of features • Close monitoring of BPs
these disorders is presented. • Weekly laboratory tests (may be modified per findings)
Gestational hypertension is charac-
Preeclampsia • Antihypertensive therapy as soon as detected (minimally
terized by a new-onset systolic blood
with severe within 30–60 minutes)
pressure (BP) ≥ 140 mmHg and/or a features • Intravenous magnesium sulfate for seizure prophylaxis
diastolic BP ≥ 90 mmHg on two occa-
• Birth at 34 0/7 weeks (after stabilization)
sions at least 4 hours apart, presenting
after 20 weeks’ gestation. It is further ° Should not be delayed for the administration of
antenatal steroids
defined by absence of proteinuria or • Close monitoring of BPs and laboratory values
severe features (defined below) with
a return to normotensive pressures Eclampsia • Lateral decubitus position
postpartum. When gestational hyper- • Prevention of maternal injury and aspiration
tension is in the severe range of ≥ 160 • Administration of oxygen
mmHg systolic and/or ≥ 110 mmHg • Magnesium sulfate for subsequent seizure prophylaxis
diastolic, it is considered preeclampsia • Timing of birth should be based on gestational age,
with severe features (ACOG, 2019). fetal presentation, and maternal and fetal condition
Preeclampsia is defined as a new-
onset systolic BP ≥ 140 mmHg and/ platelets, serum creatinine, lactate family history of preeclampsia, body
or diastolic BP ≥ 90 mmHg on two dehydrogenase, aspartate amino- mass index > 30, African American
occasions at least 4 hours apart, pre- transferase, alanine aminotransfer- race, low socioeconomic status, a
senting after 20 weeks’ gestation. ase, and an assessment of proteinuria. prior low birthweight or small for
When BPs are in the severe range A uric acid test may be indicated gestational age infant or adverse
(≥ 160 mmHg systolic and/or ≥ 110 when preeclampsia superimposed pregnancy outcome, and more than a
mmHg diastolic), they should be upon chronic hypertension is sus- 10-year pregnancy interval (ACOG,
confirmed within minutes to facili- pected. Fetal assessment should 2019). ✜
tate prompt antihypertensive treat- involve an ultrasound for fetal weight
ment. Preeclampsia is further defined and amniotic fluid volume, and ante- Kirsten Wisner is the Magnet Pro-
by presence of proteinuria (defined partum fetal testing (ACOG, 2019). gram Director at Salinas Valley Me-
as preeclampsia) or any of the fol- See the table for an overview of man- morial Healthcare System, Salinas,
lowing severe features (preeclampsia agement recommendations. CA. Ms. Wisner can be reached via
with severe features): thrombocyto- The guideline recommends low- e-mail at [email protected]
penia, renal insufficiency, impaired dose aspirin (81 mg/day) beginning The author declares no conflicts of
hepatic function, pulmonary edema, between 12 and 28 weeks of gesta- interest.
or new-onset headache. See the tion (optimally before 16 weeks) for
ACOG Practice Bulletin for full women with any high-risk factor for Copyright © 2019 Wolters Kluwer
details on these criteria. Note that preeclampsia and one or more of the Health, Inc. All rights reserved.
BPs in the severe range are consid- moderate-risk factors. High-risk fac-
DOI:10.1097/NMC.0000000000000523
ered a severe feature (ACOG, 2019). tors include a history of preeclamp-
Initial evaluation of a woman pre- sia, multiple gestation, renal or Reference
senting with a hypertensive disorder autoimmune disease, diabetes melli- American College of Obstetricians and Gyne-
of pregnancy should include a full tus type 1 or 2, and chronic hyperten- cologists. (2019). Gestational hypertension
and preeclampsia (Practice Bulletin No.
maternal and fetal evaluation includ- sion. Moderate-risk factors include a 202). Obstetrics & Gynecology, 133(1),
ing a complete blood cell count with first pregnancy, maternal age ≥ 35, e1-e25. doi:10.1097/AOG.0000000000003018

170 volume 44 | number 3 May/June 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.