Download: Hypertension in pregnancy (NICE clinical guideline 107)

The management of hypertensive disorders during pregnancy Hypertension in pregnancy (NICE clinical guideline 107) NICE clinical guideline 107 – Hypertension in pregnancy: the management of hypertensive disorders during pregnancy 3 Introduction Hypertensive disorders during pregnancy occur in women with pre-existing primary or secondary chronic hypertension, and in women who develop new- onset hypertension in the second half of pregnancy. Hypertensive disorders during pregnancy carry risks for the woman and the baby. Although the rate of eclampsia in the United Kingdom (UK) appears to have fallen, hypertension in pregnancy remains one of the leading causes of maternal death in the UK. Hypertensive disorders during pregnancy may also result in substantial maternal morbidity. A UK study reported that one-third of severe maternal morbidity was a consequence of hypertensive conditions. A study from one region of the UK reported that 1 in 20 (5%) women with severe pre-eclampsia or eclampsia were admitted to intensive care. More recently, the long-term consequences for women with a diagnosis of hypertension during pregnancy have become clear, in particular chronic hypertension and an increase in lifetime cardiovascular risk.

NICE clinical guideline 107 – Hypertension in pregnancy: the management of hypertensive disorders during pregnancy 6 Key priorities for implementation Reducing the risk of hypertensive disorders in pregnancy • Advise women at high risk of pre-eclampsia to take 75 mg of aspirin? ? hypertensive disease during a previous pregnancy daily from 12 weeks until the birth of the baby. Women at high risk are those with any of the following: ? chronic kidney disease ? autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome ? type 1 or type 2 diabetes ? chronic hypertension. [1.1.2.1] Management of pregnancy with chronic hypertension • Tell women who take angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): ? that there is an increased risk of congenital abnormalities if these drugs are taken during pregnancy ? to discuss other antihypertensive treatment with the healthcare professional responsible for managing their hypertension, if they are planning pregnancy. [1.2.1.1] • In pregnant women with uncomplicated chronic hypertension aim to keep blood pressure lower than 150/100 mmHg. [1.2.3.1] Assessment of proteinuria in hypertensive disorders of pregnancy • Use an automated reagent-strip reading device or a spot urinary protein:creatinine ratio for estimating proteinuria in a secondary care setting. [1.3.1.1] ? In this guideline, drug names are marked with an asterisk if they do not have UK marketing authorisation for the indication in question at the time of publication (August 2010). Informed consent should be obtained and documented….

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