That said, complete bed rest is not recommended by the 2013
Task Force. First, this is pragmatically unachievable because of the severe restrictions it places on otherwise well women.
Also, it likely predisposes to thromboembolism (Knight, 2007).
To reduce activity, several studies have addressed the beneits of inpatient care and outpatient management.
he concept of prolonged hospitalization for women with hypertension arose during the 1970s. At Parkland Hospital, an inpatient antepartum unit was established in 1973 by Dr. Peggy Whalley in large part to provide care for such women. Initial results from this unit were reported by Hauth (1976) and Gilstrap (1978) and their coworkers. Most hospitalized womenJJ have a beneficial response characterized by amelioration or improvement of hypertension. These women are not "cure, and neary 90 percent have recurrent hypertension bore or during labor. By 2016, more than 10,000 nulliparas with mild-to-moderate, early-onset hypertension during pregnancy had been managed successfully in this unit. Provider costsnot charges-for this relatively simple physical facility, modest nursing care, no drugs other than iron and folate supplements, and few essential laboratory tests are minimal compared with the cost of neonatal intensive care for a preterm neonate. Importantly, none of these women have sufered thromboembolic disease.
Many clinicians believe that further hospitalization is not warranted if hypertension abates within a few days, and this has legitimized third-party payers to deny hospitalization reimbursement. Consequently, many women with mild-tomoderate hypertension are managed at home. Outpatient management may continue as long as preeclampsia syndrome does not worsen and fetal jeopardy is not suspected. Sedentary activity throughout the greater part of the day is recommended. These women are instructed in detail to report symptoms. Home blood pressure and urine protein monitoring or frequent evaluations by a visiting nurse may prove beneficial.
To assess this approach, 11r82 nulliparas with mild gestational hypertension-20 percent had proteinuria-were managed with home health care (Barton, 2002). Their mean gestational ages were 32 to 33 weeks at enrollment and 36 to 37 weeks at delivery. Severe preeclampsia developed in approximately 20 percent, about 3 percent developed HELLP syndrome, and two
Day Unit 24 57 23 36 0 39.8 1n.1 3320 0 Usual Care 30 54 21 36.5 21 39 5.1 3340 0 Turnbull (2004) 374b Hospitalization 125 63 0 35.9 22 39 S.5 3330 3.S 0 Day Unit 249 62 0 36.2 22 39.7 7.2 3300 2.3 0 aExciuded women with proteinuria at study entry.
blncluded women with sl+ proteinuria.
BW = birthweight; EGA = estimated gestational age; HTN = hypertension; Parao= nulliparas; PMR = perinatal mortality rate; Prot = proteinuria; SGA = small for gestational age.
women had eclampsia. Perinatal outcomes were generally good. In approximately 20 percent, there was fetal-growth restriction, and the perinatal mortality rate was 4.2 per 1000 births.