Accordingly, the quality of evidence for the recommendations in this document has not. Pregnancyinduced hypertension is a major cause of maternal and fetal morbidity and mortality. Hypertension treatment summary bnf content published by nice. Gestational hypertension is often benign but may also be an early stage. Hypertension during pregnancy specific disorders cont. Women with pregnancyinduced hypertension pih are at increased risk for preeclampsia, cesarean delivery, renal dysfunction, and placental abruption. Pdf format index of hypertension bundle content changes november 2015.
Gestational hypertension is often benign but may also be an early stage in the development of. Report of the american college of obstetricians and gynecologists task force on hypertension in pregnancy. New nice guideline update on hypertension in pregnancy. The guideline is a partial update of the 2010 nice clinical guideline on hypertension in pregnancy. Usually it starts after youve been pregnant for about 20 weeks. Preeclampsia, transient gestational hypertension, and gestational hypertension are characterized by the new onset of hypertension bp. Hypertension in pregnancy may indicate a chronic medical problem, gestational hypertension new hypertension without proteinuria or preeclampsia new. Hypertensive disorders of pregnancy refer to online version, destroy printed copies after use page 4 of 32 flowchart. Hypertension in pregnancy was developed by the task force on hypertension in pregnancy. Maternal safety bundle for severe hypertension in pregnancy. Different diseases with a similar phenotype hypertension primiparity is a strong risk factor for preeclampsia, but not for gh the recurrence risk for gestational hypertension is 40% for pe 5% total blood and plasma volumes are significantly. This cks topic also does not cover the management of hypertension in people with chronic kidney disease, hypertension in children, hypertension during pregnancy, or secondary hypertension caused by conditions such as renal, endocrine, or vascular disorders. The incidence of the hypertensive disorders of pregnancy can be expected to increase in settings where there is a trend towards an older and more. Hypertension in pregnancy may indicate a chronic medical problem, gestational hypertension new hypertension without proteinuria or preeclampsia new hypertension with new proteinuria.
Nice bites hypertension in pregnancy sps specialist. It aims to reduce the risk of cardiovascular problems such as heart attacks and strokes by helping healthcare professionals to diagnose hypertension accurately and treat it effectively. Healthcare professionals women who develop hypertension during pregnancy, who have hypertension and wish to. Diagnosis and management of hypertension in pregnancy. The primary comparison was the detection rate of screening recommended by the nice guidelines vs a minicombined test a bayes theorembased method involving maternal factors, mean arterial pressure map, and serum pregnancyassociated plasma proteina pappa in predicting preeclampsia occurring at any gestational age, after adjustment. Who library cataloguing in publication data who recommendations for prevention and treatment of preeclampsia and eclampsia.
List the risk factors for hypertension during pregnancy in particular, preeclampsia. Auscultatory technique the national institute for health and care excellence. Definitions and stratification of hypertension in pregnancy 7 a. Its common to develop hypertension, or high blood pressure, during pregnancy. Similar to escesh, nice recommends spironolactone, other diuretics, and alpha or betablockers for resistant hypertension. Women who develop hypertension during pregnancy, who have hypertension and wish to conceive, and who have had a pregnancy complicated by hypertension, and their relatives and carers. This summary covers the diagnosis and management of hypertension during pregnancy, labour, and birth. Severity of hypertension in pregnancy is considered on the basis of the presence of target organ involvement ie, maternal or the fetus itself as well as the actual bp level.
Jun 07, 2018 hypertension in pregnancy is defined as an sbp. Feb 09, 2017 prevalence of hypertension in pregnancy was found to be 6. Guidance for hypertension in those with diabetes was included in the nice hypertension guideline for the first time, having previously fallen. Guidance for hypertension in those with diabetes was included in the nice hypertension guideline for the first time, having previously fallen into the remit of the diabetes guideline. It aims to improve care during pregnancy, labour and birth for women and their babies. This guideline covers diagnosing and managing hypertension high blood pressure, including preeclampsia, during pregnancy, labour, birth and immediately after birth. May 24, 2015 gestational hypertension to preeclampsia the pathophysiology of gestational hypertension is unknown. Hypertension is the major cause of cardiovascular disease cvd, responsible for over 10 million deaths worldwide every year. The aim of the following publication was to present the statement on management of pregnancy hypertension from the current guidelines of the polish society of arterial hypertension 2011 to. Nice has also produced a guideline on hypertension in pregnancy. Gestational hypertension guidelines bmj best practice.
Hypertension in pregnancy by dr langer recorded on 9 2 16. This includes women with chronic hypertensionwhich may be diagnosed before pregnancy or in the early stages of pregnancy nice guideline hypertension in pregnancy. See also nice s guideline on hypertension in pregnancy. Hypertension in pregnancy nice clinical guideline 107 ascalema. Mildtomoderate systolic bp 140 159 mmhg andor diastolic bp 90 109 mmhg severe systolic bp 160 mmhg andor diastolic bp 110 mmhg. Unfortunately, there is a relative lack of highquality. Find out more we run many projects in order to discover and advance new techniques in the field. Chronic hypertension can mimic gestational hypertension and strongly predisposes to superimposed pre. The information in hypertension in pregnancy should not be viewed as a body of rigid rules.
It is intended that this be a living document, to be updated when needed as more research becomes available to influence good clinical practice. Nice bites hypertension in pregnancy published 19th october 2010, updated 3rd march 2020 north west medicines information centre. Classification of the hypertensive disorders of pregnancy. Severe hypertension in pregnancy revised november 2015. This guideline includes new and updated recommendations on. A service of the national library of medicine, national institutes of health. Pregnancy induced hypertension is a major cause of maternal and fetal morbidity and mortality. View notes nice 2010 hypertension in pregnancy diagnosis and management from surgery 304 at medical university sofia. The need for lowering blood pressure in women with severe hypertension is generally accepted 2 345. These are the recommendations of a multidisciplinary working party convened by the society of obstetric medicine of australia and new zealand. Hypertension complicates 10 20% of all pregnancies. Gestational hypertension in pregnancy nice pathways bring together everything nice says on a topic in an interactive flowchart. Classification of hypertensive disorders in pregnancy hdp 10 a. Nice hypertension in pregnancy guideline nice guideline.
Thrombosis and embolism during pregnancy and the puerperium, reducing the risk greentop. Gestational hypertension also referred to as pregnancyinduced hypertension pih is a condition characterized by high blood pressure during pregnancy gestational hypertension can lead to a serious condition called preeclampsia, also referred to as toxemia. Auscultatory technique the national institute for health and care excellence nice 5 antenatal care guidance recommends bp. The management of hypertensive disorders during pregnancy. Apr 04, 2018 the primary comparison was the detection rate of screening recommended by the nice guidelines vs a minicombined test a bayes theorembased method involving maternal factors, mean arterial pressure map, and serum pregnancyassociated plasma proteina pappa in predicting preeclampsia occurring at any gestational age, after adjustment. This includes women with chronic hypertensionwhich may be diagnosed before pregnancy or in the early stages of pregnancy nice clinical guideline 107 this clinical guideline contains recommendations for the diagnosis and management of hypertensive disorders during pregnancy in the antenatal, intrapartum and postnatal periods. The overall strategies of defining and managing these conditions are aimed at preventing cardiovascular and cerebrovascular complications in the mother without jeopardizing fetal wellbeing. Dr angela langer discusses current guideline for hypertension in pregnancy. Nice pathways are interactive and designed to be used online. Hypertension in pregnancy hypertension in pregnant is the elevation of the blood pressure bp to be. Gestational hypertension to preeclampsia the pathophysiology of gestational hypertension is unknown. Hypertensive disorders during pregnancy carry risks for the woman and the baby. Clinical practice guideline pregnancy and renal disease.
Hypertensive disorders represent major causes of pregnancyrelated maternal mortality worldwide. Hypertension in pregnancy is a common condition, affecting about 10% of pregnant women. Nice hypertension in pregnancy guideline guidelines. Although the rate of eclampsia in the united kingdom uk appears to have fallen, hypertension in pregnancy remains one of the leading causes of maternal death in. Eight hundred and fortyfive women with new hypertension in the second half of pregnancy, managed by a uniform protocol 661 in the retrospective analysis, 184 in the prospective study. Nice clinical guideline 107 hypertension in pregnancy. Diagnosis and management of hypertension in pregnancy the bmj. New nice guideline update on hypertension in pregnancy rcog. Making decisions using nice guidelines explains how we use words to show the strength or certainty of our recommendations, and has. Guideline for the management of hypertensive disorders of. This guideline updates and replaces nice guideline cg107 august 2010. Hypertension during pregnancy affects about 68% of pregnant women.
The current definition and treatment recommendations for elevated blood pressure during pregnancy in the us have remained unchanged for many years, unlike the recommendations for hypertension treatment in the general population. There is consensus that introduction of the 2010 nice evidencebased guidelines, together with the findings from the confidential enquiry into maternal deaths. The esc suggests that gestational hypertension should resolve within 42 days postpartum, which is the puerperal period, and that preexisting hypertension persists beyond this period. Please go to nice for any updates to this guideline nice bites is a monthly bulletin which summarises key prescribing points from nice guidance. National collaborating centre for womens and childrens health uk. Hypertension in pregnancy nice clinical guideline 107 this clinical guideline contains recommendations for the diagnosis and management of hypertensive disorders during pregnancy in the antenatal, intrapartum and postnatal periods. Classification of the hypertensive disorders of pregnancy 35 are complicated by preexisting hypertension, 56% by gestational hypertension without proteinuria, and 12% by preeclampsia 4,5. Its prevention and management is a proven costeffective way to reduce the burden of cvd fatal and nonfatal. Ongoing monitoring for increased hypertension and proteinuria, consideration of expectant management or labor. Diagnosis and management cg107, 2011 update awaited 2019. For information on how nice is supporting the nhs and social care, view our new rapid guidelines and evidence. The guidelines are general and intended to be adapted to many different situations.
Recommendations on the management of hypertension and blood pressure thresholds are from the national institute for health and care excellence nicehypertension in adults. Nice guidelines the use of aspirin for the prevention of preeclampsia in highrisk pregnant women was introduced by nice in 2010 nice 2010,cg107. It is the second leading cause of maternal death and perinatal morbidity and mortality after severe bleeding. We aim to promote research excellence in the field of hypertensive disorders of pregnancy. Aug 25, 2010 this guideline has been updated and replaced by hypertension in pregnancy. Oral nifedipine or intravenous labetalol for hypertensive emergency in pregnancy. Gestational hypertension pregnancy induced hypertension which develops after 20 weeks of gestation and may be either transient hypertension of pregnancy or chronic hypertension not identified until the latter half of pregnancy.
Women should be offered appropriate lifestyle and dietary advice to minimise this risk hypertension in pregnancy is a common condition, affecting about 10% of. This cks topic is largely based on the national institute for health and care excellence nice guideline hypertension in pregnancy. During pregnancy, chronic hypertension is categorized as. Commonly prescribed drugs in pregnancy for further information including full details of contraindications, cautions, drug interactions and adverse effects always check with bnf uk or spc uk. Chronic hypertension can mimic gestational hypertension and strongly predisposes to superimposed preeclampsia. Clinical questions hypertension in pregnancy ncbi bookshelf. Discuss the treatment of hypertensive disorders of pregnancy. New evidence has recently been published about the risks of chronic hypertension in pregnancy and the benefit of aspirin for the prevention of preeclampsia. They are updated regularly as new nice guidance is published. This guidance has been updated and replaced by nice guideline. It is therefore important that all healthcare providers are aware of the issues surrounding accuracy of bp measurement in pregnancy. Undernutrition in chronic kidney disease, june 2019 rcog. Hypertension in pregnancy nice clinical guideline 107.
Clinical management of primary hypertension in adults nice guideline. Our understanding of the origin of these disorders is evolving. The national institute of health and clinical excellence nice clinical guideline on hypertension in pregnancy. This guidance has been updated and replaced by nice guideline ng3. Reprinted with permission from american college of obstetricians and gynecool gists hy. Guidelines for the management of hypertensive disorders of pregnancy 2014 lowe sa, bowyer l, lust k, mcmahon l, morton m, north ra, paech m. Nice hypertension in pregnancy guideline guidelines for nurses. Nice clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the nhs in england and wales.
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