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Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK)

Version: August 2010

Medical management of severe hypertension or severe pre-eclampsia in a critical care setting

Severe pre-eclampsia continues to cause maternal and perinatal morbidity. The UK Confidential Enquiries into Maternal Death have consistently reported substandard care in the management of these women. Protocols and guidelines have been developed in most units and more recently supported by guidance in this area from the Royal College of Obstetricians and Gynaecologists (RCOG). This section reviews the evidence for the acute management of severe pre-eclampsia that is conducted within a critical care setting, or what is more usually known as high-dependency care. In most circumstances, this occurs following a decision to end the pregnancy.

Summary of recommendations and care pathway

This clinical guideline contains recommendations for the diagnosis and management of hypertensive disorders during pregnancy in the antenatal, intrapartum and postnatal periods. It includes recommendations for women with chronic hypertension who wish to conceive and recommendations for advice to women after a pregnancy complicated by hypertension.

Management of pregnancy with pre-eclampsia

The risk of maternal and perinatal mortality and morbidity is increased once a diagnosis of pre-eclampsia is made. Pre-eclampsia is a multisystem disease and the level of hypertension is not the only consideration. Measurement of biochemical and haematological parameters may be useful in determining the systems involved and in establishing the risk of serious adverse outcomes in the women or baby.

Management of pregnancy with chronic hypertension

Women with chronic hypertension are at increased risk of pre-eclampsia but even in the absence of this there is increased perinatal mortality. The women frequently have co-morbidities and require care above that offered routinely.

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