Hypertensive Disorders of Pregnancy

Hypertension in Pregnancy: ISSHP Recommendations 257. Proteinuria is not mandatory for a diagnosis of preeclampsia.Rather, this is diagnosed by the presence of de novo hypertension after 20 weeks' gestation accompanied by proteinuria and/or evidence of maternal acute kidney injury (AKI), liver dysfunction, neurological features, hemolysis or thrombocytopenia, or fetal growth restriction.Preeclampsia may develop or be recognized for the first time intrapartum or early postpartum in some cases.8.The hemolysis, elevated liver enzymes, low platelets syndrome is a (serious) manifestation of preeclampsia and not a separate disorder. Diagnosis of Hypertension and Proteinuria1. Home BP monitoring is a useful adjunct in the management of chronic hypertension and is mandatory in the management of white-coat hypertension.2. Proteinuria is optimally assessed by screening with automated dipstick urinalysis and then if positive quantifying with a urine protein/creatinine ratio.A ratio ≥30 mg/ mmol (0.3 mg/mg) is abnormal. Prediction and Prevention of Preeclampsia and Associated Complications HypertensionJuly 2018be given to treating any hypertension before day 6 postpartum with antihypertensive therapy.Thereafter, antihypertensive therapy may be withdrawn slowly over days but not ceased abruptly.It is important to note that eclamptic seizures may develop for the first time in the early postpartum period.2. Nonsteroidal anti-inflammatory drugs (NSAIDs) for postpartum analgesia should be avoided in women with preeclampsia unless other analgesics are not working; this is especially important if they have known renal disease, or preeclampsia is associated with placental abruption, AKI, or other known risk factors for AKI (eg, sepsis, postpartum hemorrhage).3.All women should be reviewed at 3 months postpartum to ensure that BP, urinalysis, and any laboratory abnormalities have normalized.If proteinuria or hypertension persists, then appropriate referral for further investigations should be initiated.4.There are significant long-term cardiovascular risks for women with chronic hypertension and those who have had gestational hypertension or preeclampsia.One initial recommendation may be to aim to achieve prepregnancy weight by 12 months and to limit interpregnancy weight gain through healthy lifestyle.5. Annual medical review is advised life-long, and all such women should adopt a healthy lifestyle that includes exercise, eating well, and aiming for ideal body weight.