Hypertension in pregnancy management

-

 Hypertension in pregnancy


Advise pregnant women at high risk of pre-eclampsia to take 75–150 mg of aspirin daily from 12 weeks until the birth of the baby , those with any of the following: •hypertensive disease during a previous pregnancy

•chronic kidney disease

• autoimmune disease such as systemic lupus erythematosus or antiphospholipid syndrome

• type 1 or type 2 diabetes • chronic hypertension.


Advise pregnant women with more than 1 moderate risk factor for preeclampsia to take 75–150 mg of aspirin. Factors indicating moderate risk are: • first pregnancy • age 40 years or older • pregnancy interval of more than 10 years • body mass index (BMI) of 35 kg/m2• family history of pre-eclampsia •multi -fetal pregnancy


Stop antihypertensive treatment in women taking ACE inhibitors or ARBs if they become pregnant (preferably within 2 working days of notification of pregnancy) and offer alternatives. 

 Advise women who take thiazide or thiazide-like diuretics:• that there may be an increased risk of congenital abnormalities and neonatal complications if these drugs are taken during pregnancy.


Offer antihypertensive treatment to pregnant women who have chronic hypertension and who are not already on treatment if they have: • sustained systolic blood pressure of 140 mmHg or higher or • sustained diastolic blood pressure of 90 mmHg or higher. 


When using medicines to treat hypertension in pregnancy, aim for a target blood pressure of 135/85 mmHg.


 Consider labetalol to treat chronic hypertension in pregnant women. Consider nifedipine for women in whom labetalol is not suitable, or methyldopa if both are not suitable.


Timing of birth::

 Do not offer planned early birth before 37 weeks to women with chronic hypertension whose blood pressure is lower than 160/110 mmHg, with or without antihypertensive treatment, unless there are other medical indications.

 For women with chronic hypertension whose blood pressure is lower than 160/ 110 mmHg after 37 weeks, with or without antihypertensive treatment, timing of birth and maternal and fetal indications for birth should be agreed between the woman and the senior obstetrician.


Postnatal investigation, monitoring and treatment::

 In women with chronic hypertension who have given birth, measure blood pressure: • daily for the first 2 days after birth • at least once between day 3 and day 5 after birth • as clinically indicated if antihypertensive treatment is changed after birth. 

 In women with chronic hypertension who have given birth: • aim to keep blood pressure lower than 140/90 mmHg• continue antihypertensive treatment, if required• offer a review of antihypertensive treatment 2 weeks after the birth, with their GP or specialist. 


 If a woman has taken methyldopa to treat chronic hypertension during pregnancy, stop within 2 days after the birth and change to an alternative antihypertensive treatment.

Offer women with chronic hypertension a medical review 6–8 weeks after the birth with their GP or specialist as appropriate.


Offer enalapril to treat hypertension in women during the postnatal period, with appropriate monitoring of maternal renal function and maternal serum potassium.

 For women of black African or Caribbean family origin with hypertension during the postnatal period, consider antihypertensive treatment with: • nifedipine or • amlodipine if the woman has previously used this to successfully control her blood pressure. 

 For women with hypertension in the postnatal period, if blood pressure is not controlled with a single medicine, consider a combination of nifedipine and enalapril. If this combination is not tolerated or is ineffective,

consider either: • adding atenolol or labetalol to the combination treatment or • swapping 1 of the medicines already being used for atenolol or labetalol.

 When treating women with antihypertensive medication during the postnatal period, use medicines that are taken once daily when possible.

 Where possible, avoid using diuretics or angiotensin receptor blockers to treat

hypertension in women in the postnatal period who are breastfeeding or expressing milk. 


Source:: NICE guidance


By:: Dr. Manilal Biswas

SSMC (2012-13)

Comments

Post a Comment

Popular posts from this blog

Withdrawal, absence and cancellation of MRCP UK EXAM

-
Withdrawal, absence and cancellation of examinations 5.1 Withdrawal from the examination and refund of examination fees Notice of withdrawal from any part of the examination must be given in writing (by email) to the appropriate Administration Office, (or MRCP(UK) if the examination is to be taken outside the UK). Candidates should give their RCP Code Number, full name and date of birth in their request to withdraw to allow College staff to identify candidates easily. Examination applications and/or fees cannot be transferred from one examination to another. Candidates whose withdrawal request is received on or before the application closing date will be refunded 90% of the examination fee paid (10% of the fee is retained as an administrative charge). Refunds will not be made where candidates submit their withdrawal request after the closing date unless there are circumstances deemed exceptional that can be substantiated. (This does not apply to PACES candidates who are allocated place...
Read more

এমবিবিএস বাংলাদেশ, খরচ,সময় , বিষয়

-
 MBBS অনেকেই জিজ্ঞাসা করে এমবিবিএস কোন সাবজেক্ট,কোন বিষয়ে বিশেষজ্ঞ হচ্ছি,কত দিন পড়া,কি কি পড়া লাগে ইত্যাদি। সেগুলা নিয়ে কিছু কথা বলি। এমবিবিএস এ কখন ভর্তি হয়? HSC pass করার পর,সাইন্স থেকে অবশ্যই , এমবিবিএস ভর্তি পরীক্ষার জন্য সময় মত ফরম পূরণ করতে হয়।এরপর নির্দিষ্ট দিনে সারাদেশে একই প্রশ্নে একই সাথে পরীক্ষা অনুষ্ঠিত হয়। পরীক্ষায় মার্ক অনুযায়ী মেডিক্যাল কলেজের সিরিয়াল আসে।অর্থাৎ যার মার্ক বেশি সে উপরের দিকে সিরিয়াল এর মেডিক্যাল এ।এই সিরিয়াল কোন মেডিক্যাল আগে বা পরে এগুলা website e দেওয়া আছে। 2 বার পরীক্ষা দিতে পারে মোট।যে বছর এসএসসি পাস করে সেখান থেকে দ্বিতীয় ও তৃতীয় বছর। এমবিবিএস কোর্সে কত সময় লাগে? 5 বছরের কোর্স, শেষ বছরের শেষ দিকে ফাইনাল পরীক্ষা অনুষ্ঠিত হয়।রেজাল্ট দিতে আরো 3 - 4 মাস লাগে। মোট সময় লাগে 5 বছর 3 মাস প্রায়। এরপর 1 বছর ইন্টার্নশিপ। ইন্টার্নশিপ শেষ হলে BMDC কর্তৃক দেশে প্রাক্টিস করতে রেজিস্ট্রেসন নম্বর দেওয়া হয়।তখন সে রেজিস্ট্রার্ড ডক্টর। কি কি সাবজেক্ট পড়তে হয়?  এখানে যতগুলো বড় পরীক্ষা হয় সেগুলা প্রফেশনাল এক্সাম,প্রফ বা পেশাগত পরীক্ষা বল...
Read more

MRCP UK, when you get the degree

-
Progress through the diploma 8.1 On passing Part 1 Examination Once they have received confirmation that they have passed the Part 1 examination, candidates can apply for the MRCP(UK) Part 2 Written and/or the Part 2 Clinical (PACES) Examination (in accordance with the recommendations for necessary clinical experience detailed in MRCP advice and guidance). Candidates will be permitted seven years from the date of the Part 1 Examination at which they were successful to pass the remaining parts of the diploma. Candidates who have passed Part 1 cannot re-sit the Part 1 Examination until the seven-year period has expired. 8.2 On passing Part 2 Written Examination Candidates who have not yet passed MRCP(UK) Part 2 Clinical Examination must pass PACES before they can complete the MRCP(UK) diploma and be elected to Membership of the Royal Colleges of Physicians of the United Kingdom. Candidates do not need to wait until their result for MRCP(UK) Part 2 Written is confirmed before applying for...
Read more