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O60. Treatment of hypertension in pregnancy
Conclusions According to recent guidelines, in the absence of randomised clinical trials recommendations how hypertension should be treated in pregnant women, can only be guided by experts’ opinion based on case reports and their meta-analyses.
Source: Pregnancy Hypertension: An International Journal of Womens Cardiovascular Health - August 31, 2015 Category: OBGYN Source Type: research

Focused Update on Pharmacologic Management of Hypertensive Emergencies
AbstractPurpose of ReviewHypertensive emergency is defined as a systolic blood pressure>  180 mmHg or a diastolic blood pressure>  120 mmHg with evidence of new or progressive end-organ damage. The purpose of this paper is to review advances in the treatment of hypertensive emergencies within the last 5 years.Recent FindingsNew literature and recommendations for managing hypertensive emergencies in the setting of pregnancy, stroke, and heart failure have been published.SummaryOral nifedipine is now considered an alternative first-line therapy, along with intravenous hydralazine and labetalol for women presenti...
Source: Current Hypertension Reports - June 8, 2018 Category: Primary Care Source Type: research

Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review
ConclusionsOral nifedipine, and possibly labetalol and methyldopa, are suitable options for treatment of severe hypertension in pregnancy/postpartum.
Source: BJOG: An International Journal of Obstetrics and Gynaecology - May 16, 2014 Category: OBGYN Authors: T Firoz, LA Magee, K MacDonell, BA Payne, R Gordon, M Vidler, P Dadelszen, Tags: Systematic Review Source Type: research

Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review.
CONCLUSIONS: Oral nifedipine, and possibly labetalol and methyldopa, are suitable options for treatment of severe hypertension in pregnancy/postpartum. PMID: 24832366 [PubMed - as supplied by publisher]
Source: BJOG : An International Journal of Obstetrics and Gynaecology - May 16, 2014 Category: OBGYN Authors: Firoz T, Magee L, MacDonell K, Payne B, Gordon R, Vidler M, von Dadelszen P, the Community Level Interventions for Pre-eclampsia (CLIP) Working Group Tags: BJOG Source Type: research

Longitudinal hemodynamics in acute phase of treatment with labetalol in hypertensive pregnant women to predict need for vasodilatory therapy
ConclusionMaternal demographics and hemodynamic changes in the acute phase of labetalol monotherapy provide a powerful tool to identify hypertensive pregnant patients who are unlikely to have their BP controlled by this therapy and will consequently need additional vasodilatory therapy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Source: Ultrasound in Obstetrics and Gynecology - November 30, 2016 Category: Radiology Authors: D. Stott, M. Bolten, D. Paraschiv, I. Papastefanou, J. B. Chambers, N. A. Kametas Tags: Original Paper Source Type: research

Committee Opinion No. 692: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period.
Authors: Abstract Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the...
Source: Obstetrics and Gynecology - March 25, 2017 Category: OBGYN Tags: Obstet Gynecol Source Type: research

Committee Opinion No. 692 Summary: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period.
Authors: Abstract Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the...
Source: Obstetrics and Gynecology - March 25, 2017 Category: OBGYN Tags: Obstet Gynecol Source Type: research

Postpartum Hypertension: Etiology, Diagnosis, and Management
Conclusions and Relevance: Providers must be aware of the risks associated with postpartum hypertension and educate women about the symptoms of postpartum preeclampsia. Severe acute hypertension should be treated in a timely fashion to avoid morbidity and mortality. Women with persistent postpartum hypertension should be administered a long-acting antihypertensive agent. Target Audience: Obstetricians and gynecologists, family physicians. Learning Objectives: After completing this activity, the learner should be better able to assist patients and providers in identifying postpartum hypertension; provide a framework for t...
Source: Obstetrical and Gynecological Survey - April 1, 2017 Category: OBGYN Tags: CME Articles Source Type: research

A Pregnancy Complication to Look out for even after Pregnancy
​BY GREGORY TAYLOR, DO, & SHERIF G. EL-ALAYLI, DOA 30-year-old G5P3 presented to the ED with bilateral lower-extremity edema and headache for three days. She presented one week after an uncomplicated full-term vaginal delivery with an unremarkable pregnancy course and no prior requirement for antihypertensive therapy. The headache was described as achy to sharp, with associated photophobia. She also noted occasional vaginal spotting, which was common a few weeks after delivery. She denied any chest pain, shortness of breath, nausea or vomiting, abdominal pain, or any other symptoms. She admitted to occasional mild cr...
Source: The Case Files - August 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Management of Hypertension on the Labor and Delivery Unit: Delivering Care in the Era of Protocols and Algorithms.
CONCLUSION: Labetalol treatment was appropriately initiated in many cases; however, protocol adherence could greatly improve. Potential factors affecting protocol compliance include shift changes, communication issues, and conflicting protocols. Institutions should review protocol compliance to improve care. PMID: 30227906 [PubMed - as supplied by publisher]
Source: The Permanente journal - September 21, 2018 Category: General Medicine Tags: Perm J Source Type: research

ACOG Committee Opinion No. 767: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period.
Authors: Abstract Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the...
Source: Obstetrics and Gynecology - December 19, 2018 Category: OBGYN Tags: Obstet Gynecol Source Type: research

508: Readmission following discharge on labetalol or nifedipine for management of hypertensive disorders of pregnancy
Hypertensive disorders of pregnancy (HDP) confer significant maternal risks postpartum including risks of seizure, stroke and higher rates of postpartum readmission. Following delivery, women with blood pressure elevations are treated primarily with labetalol or nifedipine but it is unknown if one agent is more effective for blood pressure control following hospital discharge. We sought to compare rates of postpartum readmission and adverse maternal outcomes based on discharge on labetalol versus nifedipine.
Source: American Journal of Obstetrics and Gynecology - December 25, 2018 Category: OBGYN Authors: Samantha C. Do, Danielle M. Panelli, Anna I. Girsen, Sanaa Suharwardy, Jaclyn Estes, Ronald S. Gibbs, Yasser El- Sayed, Deirdre J. Lyell, Maurice L. Druzin, Jason Bentley Tags: Poster Session III Source Type: research

ACOG Committee Opinion No. 767 Summary: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period.
Authors: Abstract Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the...
Source: Obstetrics and Gynecology - January 27, 2019 Category: OBGYN Tags: Obstet Gynecol Source Type: research

Hypertensive Crisis in Pregnancy
Severe hypertension in pregnancy is a medical emergency, defined as systolic blood pressure (BP) ≥ 160 mm Hg and/or diastolic BP ≥ 110 mm Hg taken 15 minutes to 4 or more hours apart. Outside pregnancy, acute severe hypertension (HTN) is defined as a BP greater than 180/110 to 120 reproducible on 2 occasions. The lower threshold for severe HTN in pregnancy reflects the increased risk for adverse outcomes, particularly maternal stroke and death, and may be a source of under-recognition and treatment delay, particularly in nonobstetrical health care settings. Once a severe hypertension episode is recognized, antihyper...
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Cynthie K. Wautlet, Maria C. Hoffman Source Type: research