This Site. Google Scholar. Pediatrics 98 4 : — Article history Received:. Cite Icon Cite. You do not currently have access to this content. Comments Icon Comments 0.
View full article. Sign in Don't already have an account? Individual Login. Institutional Login. Sign in via OpenAthens. Pay-Per-View Access.
Buy This Article. View Your Tokens. Little information is available on the effects of antihypertensive medication during lactation. For this reason, withholding antihypertensive medications for several months is acceptable in most patients with stage I and, perhaps, stage II hypertension.
Despite initial enthusiasm for the use of calcium supplements 12 and low-dose aspirin therapy, 13 these agents appear to be ineffective, at least in women in the United States. The definitive treatment for preeclampsia is delivery of the fetus. Fetal surveillance in a pregnancy complicated by preeclampsia should consist of daily fetal movement counts and periodic fetal NST and BPP. Details of fetal assessment are shown in Table 4. Gestational hypertension hypertension only, without proteinuria, normal laboratory testing and absent symptoms.
Estimation of fetal growth and amniotic fluid status at time of diagnosis; if normal, repeat testing only if there is significant change in maternal condition.
NST at time of diagnosis. Mild preeclampsia mild hypertension, normal platelet count, liver enzymes and absent maternal symptoms. Estimation of fetal growth and amniotic fluid status at time of diagnosis; if normal, repeat testing every three weeks. Testing should be repeated immediately if there is an abrupt change in maternal condition. The goals of maternal assessment are twofold: first, to recognize preeclampsia early, and second, to monitor the mother for evidence of disease progression that would mandate either delivery or more intensive fetal surveillance.
In the absence of severe preeclampsia, serum albumin and lactic acid dehydrogenase levels, blood smear and coagulation profile need not be checked. Depending on the patient's clinical condition and the results of laboratory studies, the patient may be managed as an inpatient, in an intensive day-hospitalization program 15 if available or as an outpatient, possibly with home testing of blood pressure and urinary protein.
Laboratory studies and fetal surveillance should be followed at frequent intervals. Evidence that antihypertensive therapy improves perinatal outcomes is also lacking. Decisions about the timing of delivery hinge on whether the infant will fare better in utero or in the nursery, and whether the mother's condition will tolerate continued pregnancy.
Proposed indications for delivery are presented in Table 5. Delivery should be considered in women with severe preeclampsia after 32 to 34 weeks' gestation.
Vaginal delivery is preferred and, if maternal and fetal conditions allow, labor induction should be carried out aggressively when the decision to deliver is made, even if the cervix is unripe.
Peripartum anticonvulsive therapy is clearly indicated to prevent recurrent seizures in a patient with eclampsia and the emergence of eclampsia in patients with severe preeclampsia. While magnesium sulfate has also been administered to women with mild preeclampsia and gestational hypertension, 19 , 20 the Working Group considers that its benefits in these groups are uncertain.
The goal of blood pressure reduction in emergency situations should be a gradual reduction of blood pressure to the normal range. Hypertension and other signs of preeclampsia should remit by six to 12 weeks' postpartum.
Risk factors for recurrence include onset before 30 weeks' gestation up to 40 percent recurrence , black descent, having a different father from the previous gestation and previous preeclampsia as a multipara.
Women with clear-cut, isolated preeclampsia-eclampsia do not appear to have an increased risk of future hypertension or cardiovascular disease, but women with transient hypertension or chronic hypertension do. Hypertension is a common complication of pregnancy that may have serious consequences to the mother and fetus. When hypertension predates pregnancy, efforts should be directed toward early recognition of intrauterine growth restriction or superimposed preeclampsia, both of which are the most important contributors to adverse outcomes in this group of women.
When hypertension develops in the latter half of pregnancy, efforts should focus on distinguishing between probable transient hypertension of pregnancy, by definition a benign and retrospectively diagnosed condition, and preeclampsia-eclampsia.
Laboratory studies and close follow-up play the most important role in this distinction. The timing of delivery is the most important management decision, and the physician should carefully weigh maternal and fetal risks. Once blood pressure control is achieved, repeat as needed usually about every three hours. If no success by 20 mg IV or 30 mg IM total, consider another drug. Labetalol Normodyne : Start with 20 mg IV bolus; if effect is suboptimal, give 40 mg 10 minutes later and 80 mg every 10 minutes for two additional doses.
Use a maximum of mg. Avoid using labetalol in women with asthma or congestive heart failure. Short-acting nifedipine is not approved by the FDA for management of hypertension. Nitroprusside Nipride is rarely needed for treatment of hypertension not responding to the drugs listed above or if there are clinical findings of hypertensive encephalopathy. Start at a rate of 0. Fetal cyanide poisoning may occur if used for more than four hours. Food and Drug Administration. Already a member or subscriber?
Log in. Interested in AAFP membership? Learn more. LEE A. Address correspondence to Mark A. Zamorski, M. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest.
Sources of funding: none reported. ACOG technical bulletin. Hypertension in pregnancy. These normative data are used to classify BP levels. Since , additional BP data in children and adolescents, the use of newer classes of drugs, and the role of primary prevention of hypertension have expanded the body of knowledge regarding the classification and treatment of hypertension in the young. Objective: To report new normative BP data in children and adolescents and to provide additional information regarding the diagnosis, treatment, and prevention of hypertension in children.
The working group members produced initial draft documents that were reviewed by NHBPEP Coordinating Committee representatives as well as experts in pediatrics, cardiology, and hypertension.
0コメント