2 source(s) cited.
# Management of hypertensive disorders in pregnancy, including complications and postpartum care
LO id: `3A.WOMENS.OBS_HTN.MGMT` | importance: core
## First-line antenatal antihypertensive choice and blood pressure targets
- Antenatal drug choice is limited compared with postnatal options; labetalol and nifedipine are described as the drugs typically used, with more agents increasingly recognised as safe [source: hypertension-in-pregnancy-lecture-transcript-d4784c#p022]
- The CHIPS trial compared strict vs. more relaxed BP control: strict control produced no increase in adverse outcomes and reduced severe pre-eclampsia; this evidence underpinned a tightening of BP targets from 140/90 to 135/85, bringing them closer to renal/cardiovascular disease targets [source: hypertension-in-pregnancy-lecture-transcript-d4784c#p019]
- Home BP monitoring apps have increasingly been offered (accelerated since COVID), giving women more autonomy and reducing the burden of frequent hospital attendance [source: hypertension-in-pregnancy-lecture-transcript-d4784c#p019]
## Recognition and emergency management of severe pre-eclampsia (including magnesium sulfate, IV antihypertensives, stabilise-mother-then-deliver principle)
- Severe pre-eclampsia is a medical emergency requiring MDT management [source: hypertension-in-pregnancy-lecture-slides-5cf2f7#p015]
- Maternal stabilisation: magnesium (sulfate) and IV antihypertensive [source: hypertension-in-pregnancy-lecture-slides-5cf2f7#p015]
- Fetal consideration once mother is being managed: magnesium and steroids, with delivery once the mother is stable [source: hypertension-in-pregnancy-lecture-slides-5cf2f7#p015]
- Core principle: stabilise the mother first, then address the fetus — treat severe pre-eclampsia with the same urgency as any other medical emergency ("put out your 2222") [source: hypertension-in-pregnancy-lecture-transcript-d4784c#p022]
- Introduction of magnesium sulfate and IV labetalol, along with significant fluid restriction, are described as major contributors to reducing pulmonary-oedema-related complications in current practice [source: hypertension-in-pregnancy-lecture-transcript-d4784c#p016]
## Gestation- and severity-based decision-making on timing of delivery
- Management depends on gestation and severity: admit, take bloods (FBC/U&E/LFTs/clotting), CTG and ultrasound for fetal wellbeing, regular observations, commence antihypertensives [source: hypertension-in-pregnancy-lecture-slides-5cf2f7#p014]
- Indications for preterm delivery: uncontrollable/severe hypertension, or signs of end-organ damage [source: hypertension-in-pregnancy-lecture-slides-5cf2f7#p014]
- Not all care is inpatient — women who are well can be stabilised on antihypertensives as outpatients once bloods/monitoring are established [source: hypertension-in-pregnancy-lecture-transcript-d4784c#p014]
## Maternal complications (stroke, seizures, pulmonary oedema, AKI, HELLP, clotting abnormalities) and fetal complications (FGR, IUFD, preterm delivery, neonatal death)
- Maternal complications: stroke, seizures, pulmonary oedema, acute kidney injury, hepatic inflammation, clotting abnormalities, HELLP [source: hypertension-in-pregnancy-lecture-slides-5cf2f7#p010]
- HELLP syndrome: haemolysis, elevated liver enzymes, low platelets — a subtype/variant of pre-eclampsia rather than a separate condition [source: hypertension-in-pregnancy-lecture-transcript-d4784c#p015]
- Fetal complications: fetal growth restriction (FGR), intrauterine fetal death, preterm delivery, neonatal death; long-term sequelae for the child include increased risk of hypertension, cardiovascular disease, and diabetes [source: hypertension-in-pregnancy-lecture-slides-5cf2f7#p011]
- FGR subtypes: asymmetrical (weight/abdominal growth preferentially affected, sparing head — associated with poor placental function) vs. symmetrical (head, abdomen, and limbs proportionally small — more associated with congenital causes or constitutionally small babies) [source: hypertension-in-pregnancy-lecture-transcript-d4784c#p018]
- Pre-eclampsia symptoms are often mistaken by patients for normal pregnancy discomfort (nausea, headache, visual disturbance/flashing lights), which is why patient-facing information leaflets on warning signs are used [source: hypertension-in-pregnancy-lecture-transcript-d4784c#p014]
- Nearly 70% of maternal deaths involve a pre-existing medical disorder as a direct or indirect cause, underlining the importance of pre-pregnancy risk assessment [source: hypertension-in-pregnancy-lecture-transcript-d4784c#p017]
## Postnatal monitoring, follow-up, and long-term maternal cardiovascular risk counselling
- Postnatal course: inpatient normally around 48 hours, then regular community monitoring for 2 weeks, with follow-up via GP and community midwife [source: hypertension-in-pregnancy-lecture-slides-5cf2f7#p016]
- Postnatally, antihypertensive options are less restricted than antenatally, and switching to a once-daily formulation can be considered for convenience/adherence [source: hypertension-in-pregnancy-lecture-slides-5cf2f7#p016, hypertension-in-pregnancy-lecture-transcript-d4784c#p022]
- Women with a history of pregnancy-induced hypertension or pre-eclampsia carry a substantially increased long-term risk of hypertension (described as at least double background risk) — lifestyle counselling on this long-term cardiovascular risk is an important part of postnatal and primary-care follow-up, especially since most students/clinicians will encounter these women in community rather than obstetric settings [source: hypertension-in-pregnancy-lecture-transcript-d4784c#p023]
- Emerging research area (not yet established practice): left ventricular remodelling appears more pronounced after hypertensive pregnancies, raising the question of whether targeted postnatal cardiac follow-up or early intervention could become standard — flagged here as a future direction rather than current guidance [provenance: ai-inference]