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O Who are at risk?
O When to treat?
O How to treat?
O What are the choices of treatment?
O How to follow up?
Who are at risk?
Smith et.al. Management of Postpartum Hypertension. TOG; 2013.
When to treat?
Up to 44% of eclampsia occur within 48 hours
postnatally
Delay discharge
PET patients till day 3
Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ
1994;309:1395–400.
When to treat?
BP ≥ 150/100 mmHg
Prevent Cerebral Haemorrhage
Smith et.al. Management of Postpartum Hypertension. TOG; 2013.
How to treat?
O Criteria of IDEAL anti-hypertensive agent
to be used in the postnatal period
Effectively control BP without diurnal peak
& troughs
Minimal maternal side effects
Safe for breast-feeding
Preferably once-daily dosing
What are the choices of treatment?(acute hypertensive crisis – IV/Oral)
Antenatal Postnatal
Nifedipine
Labetalol
Hydralazine
Nifedipine
Labetalol
Hydralazine
What are the choices of treatment?(ongoing postnatal hypertension – oral treatment)
Antenatal Postnatal
**Methyldopa
Should be discontinued postnatally
due to its maternal side effect
(sedation, postural hypotension,
postnatal depression)
tds
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tds
What are the choices of treatment?(breast-feeding safety)
NICE. Hypertension in Pregnancy. The Management of
Hypertension Disorders in Pregnancy. London: NICE; 2010.
How to follow up?
O EOD BP check for 2 weeks.
O Medication should be reduced when BP is 130-
140/80-90 mmHg.
O Refer doctor if 2x BP of >150/100mmHg at 20
minutes interval.
O Hospital admission if
symptoms of pre-eclampsia, or
BP > 160/100 mmHg
O If medication is required beyond 6 weeks, need to
assess secondary cause of hypertension.
How to follow up?
NICE. Hypertension in Pregnancy. The Management of
Hypertension Disorders in Pregnancy. London: NICE; 2010.
THANKS
