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Hypertensive Crisis in Pregnancy.
Cynthie K Wautlet1, Maria C Hoffman2
1Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO, USA.
Obstetrics and Gynecology Clinics of North America
|September 19, 2022
Summary
Severe hypertension in pregnancy, defined as blood pressure (BP) ≥ 160/110 mm Hg, requires immediate antihypertensive therapy within 60 minutes. First-line treatments include IV labetalol, hydralazine, and oral nifedipine for better maternal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Cardiology
- Emergency Medicine
Background:
- Severe hypertension in pregnancy is a critical medical emergency.
- Defined by systolic blood pressure (BP) ≥ 160 mm Hg and/or diastolic BP ≥ 110 mm Hg.
- Lower BP thresholds in pregnancy (vs. non-pregnant states) highlight increased risks for maternal stroke and mortality.
Purpose of the Study:
- To emphasize the urgency of recognizing and treating severe hypertension in pregnancy.
- To highlight potential delays in diagnosis and treatment, especially in non-obstetrical settings.
- To recommend timely initiation of antihypertensive therapy.
Main Methods:
- Review of definitions and clinical guidelines for severe hypertension in pregnancy.
- Discussion of recommended first-line antihypertensive agents.
- Emphasis on prompt administration of treatment.
Main Results:
- Severe hypertension in pregnancy necessitates treatment initiation within 30-60 minutes of recognition.
- Intravenous (IV) labetalol, hydralazine, and oral immediate-release nifedipine are recommended first-line agents.
- Treatment protocols should be based on institutional guidelines and provider familiarity.
Conclusions:
- Prompt recognition and management of severe hypertension in pregnancy are crucial to prevent adverse maternal outcomes.
- Standardized treatment protocols and provider education are essential for timely and effective care.
- Utilizing recommended first-line agents ensures appropriate management of this obstetric emergency.
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