Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension, severe diastolic hypertension, or both, require urgent antihypertensive therapy. The American College of Obstetricians and Gynecologists (ACOG) has issued a committee opinion on this topic, offering both recommendations and conclusions, including:
- 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.
- Close maternal and fetal monitoring by a physician and nursing staff are advised during the treatment of acute-onset, severe hypertension.
- After initial stabilization, the team should monitor blood pressure closely and institute maintenance therapy as needed.
- Intravenous (IV) labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period.
- Immediate release oral nifedipine also may be considered as a first-line therapy, particularly when IV access is not available.
- The use of IV labetalol, IV hydralazine, or immediate release oral nifedipine for the treatment of acute-onset, severe hypertension for pregnant or postpartum patients does not require cardiac monitoring.
Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Committee Opinion No. 692. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017:129:e90–5.
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ACOG: Chronic Hypertension in Pregnancy, Obstet Gynecol; ePub 2019 Jan; Vidaeff, et al
ACOG Guidelines: Pregestational Diabetes Mellitus, Obstet Gynecol; ePub 2018 Dec; ACOG, et al
Management of Early Pregnancy Loss, Obstet Gynecol; ePub 2018 Nov; ACOG
Prophylactic Antibiotic Use in Labor & Delivery, Obstet Gynecol; 2018 Sep; Coleman, et al
USPSTF on Screening for Cervical Cancer, JAMA; 2018 Aug 21; US Preventive Services Task Force