This document discusses the management of post-partum hypertension. It outlines who is at risk, when to treat elevated blood pressure, how to treat through medication choices, and how to follow up with patients. Treatment involves using anti-hypertensive drugs like hydralazine, labetalol, and nifedipine to effectively lower blood pressure without side effects while allowing for breastfeeding. Patients should be followed closely in the first two weeks after delivery by checking blood pressure every other day and adjusting medications accordingly.
Seizures during pregnancy can cause: Slowing of the fetal heart rate. Decreased oxygen to the fetus. Fetal injury, premature separation of the placenta from the uterus (placental abruption) or miscarriage due to trauma, such as a fall, during a seizure
Seizures during pregnancy can cause: Slowing of the fetal heart rate. Decreased oxygen to the fetus. Fetal injury, premature separation of the placenta from the uterus (placental abruption) or miscarriage due to trauma, such as a fall, during a seizure
Hypertensive Disorders in Pregnancy (HDP) represented 15.4% of total numbers of maternal death- the 4th main cause after obstetric embolism, PPH and other medical non HDP conditions
2. Scopes
O Who are at risk?
O When to treat?
O How to treat?
O What are the choices of treatment?
O How to follow up?
3. Who are at risk?
Smith et.al. Management of Postpartum Hypertension. TOG; 2013.
4. When to treat?
Up to 44% of
eclampsia occur
within 48 hours
postnatally
Delay
discharge
PET patients
till day 3
Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ
1994;309:1395–400.
5. When to treat?
BP ≥ 150/100 mmHg
Prevent Cerebral
Haemorrhage
Smith et.al. Management of Postpartum Hypertension. TOG; 2013.
6. How to treat?
O Criteria of IDEAL anti-hypertensive agent
to be used in the postnatal period
Effectively control BP without diurnal peak
& troughs
Minimal maternal side effects
Safe for breast-feeding
Preferably once-daily dosing
7. What are the choices of treatment?
(acute hypertensive crisis – IV/Oral)
Antenatal Postnatal
Hydralazine
Labetalol
Nifedipine
Hydralazine
Labetalol
Nifedipine
8. What are the choices of treatment?
(ongoing postnatal hypertension – oral treatment)
Antenatal Postnatal
**Methyldopa
Should be discontinued postnatally
due to its maternal side effect
(sedation, postural hypotension,
postnatal depression)
tds
od
bd
tds
9. What are the choices of treatment?
(breast-feeding safety)
NICE. Hypertension in Pregnancy. The Management of
Hypertension Disorders in Pregnancy. London: NICE; 2010.
10. How to follow up?
O EOD BP check for 2 weeks.
O Medication should be reduced when BP is 130-
140/80-90 mmHg.
O Refer doctor if 2x BP of >150/100mmHg at 20
minutes interval.
O Hospital admission if
symptoms of pre-eclampsia, or
BP > 160/100 mmHg
O If medication is required beyond 6 weeks, need to
assess secondary cause of hypertension.
11. How to follow up?
NICE. Hypertension in Pregnancy. The Management of
Hypertension Disorders in Pregnancy. London: NICE; 2010.
