NATIONAL PROTOCOL FOR MANAGEMENT OF HYPERTENSIVE DISORDERS OF PREGNANCY MILD PRE-ECLAMPSIA AND MILD GESTATIONAL HYPERTENSION SIGNS AND SYMPTOMS MANAGEMENT Manage outpatient BP 140/90 ≥ *at 2 readings, 4 hours apart Gestational age 37 weeks monitor BP PLUS, any of ≤ and fetal wellbeing twice a week in clinic Proteinuria *at least 2+ Counsel about danger signs (headache, Headache blurry vision, upper abdominal pain) Visual disturbance Generalized edema (hand, face) Gestational age > 37 DELIVER *↑BP prior to pregnancy or < 20 weeks gestation is chronic HTN *New onset >20 weeks is pre-eclampsia or gestational HTN ↑BP * BP without proteinuria or other symptoms of pre-eclampsia is gestational ↑ HTN (management is same as pre-eclampsia) *Women with chronic HTN can have super-imposed pre-eclampsia SEVERE PRE-ECLAMPSIA AND SEVERE GESTATIONAL HYPERTENSION SIGNS AND SYMPTOMS MANAGEMENT Systolic BP 160 or Diastolic BP 110 Manage in hospital ≥ ≥ Severe headache DELIVER as soon as possible Visual disturbance Place IV cannula and urinary catheter Epigastric or right upper abdominal pain Monitor vitals especially BP & urine output Scanty urine CBC, liver and kidney function tests Hyperreflexia Give Magnesium Sulphate & continue for Pulmonary edema (dyspnea, chest pain, 24 hours after delivery increased respiratory rate, rales on Monitor for magnesium toxicity & withhold auscultation of lungs) or delay magnesium for signs of toxicity Generalized edema If Respiratory arrest give Calcium HELLP syndrome is a form of severe Gluconate 1g IV slowly (Haemolysis; Elevated Liver Give antihypertensive drugs if systolic BP ≥ function; Low Platelets) 160 or diastolic BP 110 ≥ Gestational age < 24 weeks DELIVER *Diagnosis can be made with and any of these signs and symptoms ↑BP immediately as pre-viable Gestational age 24-34 weeks administer Dexamethasone per protocol and DELIVER after 24 hours if severe BPs persist Gestational age 37 weeks DELIVER within ≥ 24 hours
NATIONAL PROTOCOL FOR MANAGEMENT OF HYPERTENSIVE DISORDERS OF PREGNANCY MILD PRE-ECLAMPSIA AND MILD GESTATIONAL HYPERTENSION SIGNS AND SYMPTOMS MANAGEMENT BP ≥ 140/90 *at 2 readings, 4 hours apart PLUS, any of Proteinuria *at least 2+ Headache Visual disturbance Generalized edema (hand, face) *↑BP prior to pregnancy or < 20 weeks gestation is chronic HTN *New onset ↑BP >20 weeks is pre-eclampsia or gestational HTN * ↑ BP without proteinuria or other symptoms of pre-eclampsia is gestational HTN (management is same as pre-eclampsia) *Women with chronic HTN can have super-imposed pre-eclampsia Manage outpatient Gestational age ≤ 37 weeks monitor BP and fetal wellbeing twice a week in clinic Counsel about danger signs (headache, blurry vision, upper abdominal pain) Gestational age > 37 DELIVER SEVERE PRE-ECLAMPSIA AND SEVERE GESTATIONAL HYPERTENSION SIGNS AND SYMPTOMS MANAGEMENT Systolic BP ≥ 160 or Diastolic BP ≥ 110 Severe headache Visual disturbance Epigastric or right upper abdominal pain Scanty urine Hyperreflexia Pulmonary edema (dyspnea, chest pain, increased respiratory rate, rales on auscultation of lungs) Generalized edema HELLP syndrome is a form of severe (Haemolysis; Elevated Liver function; Low Platelets) *Diagnosis can be made with ↑BP and any of these signs and symptoms Manage in hospital DELIVER as soon as possible Place IV cannula and urinary catheter Monitor vitals especially BP & urine output CBC, liver and kidney function tests Give Magnesium Sulphate & continue for 24 hours after delivery Monitor for magnesium toxicity & withhold or delay magnesium for signs of toxicity If Respiratory arrest give Calcium Gluconate 1g IV slowly Give antihypertensive drugs if systolic BP ≥ 160 or diastolic BP ≥ 110 Gestational age < 24 weeks DELIVER immediately as pre-viable Gestational age 24-34 weeks administer Dexamethasone per protocol and DELIVER after 24 hours if severe BPs persist Gestational age ≥ 37 weeks DELIVER within 24 hours