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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

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

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

Use of Antihypertensive Medications During Delivery Hospitalizations Complicated by Preeclampsia.
CONCLUSION: Use of multiple antihypertensive agents to treat preeclamptic women increased over the study period for women with mild, superimposed, and severe preeclampsia. There was substantial hospital variation in use of antihypertensive agents. This trend was associated with decreased risk of maternal stroke. PMID: 29420396 [PubMed - as supplied by publisher]
Source: Obstetrics and Gynecology - February 5, 2018 Category: OBGYN Authors: Cleary KL, Siddiq Z, Ananth CV, Wright JD, Too G, DʼAlton ME, Friedman AM 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

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

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

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