It is estimated that ten million women develop preeclampsia each year around the world, with 76,000 deaths due preeclampsia and related hypertensive disorders. It is also responsible for 50,000 stillbirths and early neonatal deaths in developing nations.
A woman in
developing country is seven times more likely to develop preeclampsia than a
woman in a developed country, contributing to 10-25% of all Maternal mortality.
In the
United States, preeclampsia complicates approximately 3-5% of pregnancies,
accounting for 10-15% of maternal deaths and 3% of perinatal deaths.
ACOG says “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.”
ACOG committee
opinion was published online ahead of print in Journal of Obstetrics and Gynecology.
Women who
are pregnant or postpartum presenting with acute onset severe systolic (greater
than or equal to 160 mm Hg) as well as severe diastolic hypertension (greater
than or equal to 110 mm Hg) require urgent antihypertensive therapy.
Hospitals,
doctor’s office and other institutions handling emergencies should initiate
treatment with first line drugs within 30-60 minutes of confirming the
diagnosis to prevent maternal stroke.
Intravenous
labetalol and hydralazine have long been used as the first line drugs in
managing hypertensive emergencies in antenatal and postnatal women.
Recent available
evidence suggests that immediate release oral nifedipine may also be considered
an alternative first line therapy, especially in circumstances when an IV line
is not secured. Some studies in recent time have shown that it brings down BP
faster than labetalol and hydralazine. Concurrent use of Nifedipine and
Magnesium Sulfate requires tertiary care setup and close monitoring of mother’s
vital signs.
Use of all
these three drugs does not requires cardiac monitoring.
In rare
cases all the three drugs, labetalol, hydralazine and nifedipine may fail to
relieve acute hypertensive emergency. In such circumstances, expert opinion of
maternal-fetal medicine specialist, anesthesiologist and critical care
subspecialist is sought. The second line alternative to be considered are nicardipine
or esmolol by infusion pump.
Once the
blood pressure is stabilized, detail evaluation of maternal and fetal well-being
is carried out to make plans for long term drug therapy and timing of delivery.
The American
College of Obstetricians and Gynecologists has identified additional resources
on topics related to this document that may be helpful for ob-gyns, other
health care providers, and patients. It may be viewed at www.acog.org/More-Info/Hypertension In Pregnancy.
The full
text of the ACOG recommendations and suggestions can be accessed here.
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