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- The second half of pregnancy is often characterized
as ≥20 weeks of gestation for simplicity
- The postpartum period is generally accepted as the 6 weeks after delivery
Women with chronic hypertension are
at increased risk for placental abruption, preeclampsia, low birth weight,
cesarean delivery, premature birth, and fetal demise
Gestational hypertension is hypertension
present only after the 20th week of pregnancy
or in the immediate postpartum period but without proteinuria.
Labetalol, methyldopa, nifedipine, and hydralazine.
All anti-hypertensive drugs cross the placenta.
For acute management of hypertensive emergencies,
hydralazine 5 mg IV or IM, labetalol 20 mg IV, or nifedipine 10 to 30 mg PO
(not a U.S. Food and Drug Administration–approved indication)
may be used during pregnancy.
ACEI and ARB are contraindicated because
of their teratogenic effects on fetal scalp, lungs, and kidneys.
Preeclampsia is associated with intrauterine growth retardation, premature labor,
low birth weight, abruptio placentae, and future risk of maternal cardiovascular disease
Other important risk factors for preeclampsia include maternal age >40 years old,
hypertension, diabetes, renal disease, collagen vascular disease, and multiple gestation.
Low-dose aspirin therapy can prevent preeclampsia and its complications
Preeclampsia with severe features
Severe blood pressure elevation
SBP ≥ 160 mmHg or DBP ≥ 110 mmHg 兩次間隔 4 hr
Symptoms of CNS dysfunction
New-onset cerebral or visual disturbance, such as:
Photopsia, scotomata, cortical blindness, retinal vasospasm
Severe headache (ie, incapacitating, "the worst headache I've ever had")
or headache that persists and progresses despite analgesic therapy
and not accounted for by alternative diagnoses
Hepatic abnormality
Severe persistent RUQ or epigastric pain unresponsive to medication
and not accounted for by an alternative diagnosis
or serum transaminase concentration ≥ 2 times
the upper limit of the normal range, or both
Thrombocytopenia < 100,000 platelets/microL
Renal abnormality
Serum creatinine > 1.1 mg/dL
or a doubling of the serum creatinine
concentration in the absence of other renal disease
Proteinuria > 5g/24hrs
Oliguria < 500 ml/24hrs
Pulmonary edema
The only definitive resolution for preeclampsia is delivery.
Severe preeclampsia (blood pressure >160 mm Hg)
with antihypertensive agents and IV magnesium sulfate.
Consult with the obstetrician for admission
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