# PROBLEM: Hypertensive Disorders in Pregnancy (outpatient management)

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| **Chronic HTN**                                                       |
|                                                                       |
| [Definition]{.underline}: Mild: SBP \>=140 mm Hg, DBP\>=90 mm Hg      |
| Severe: SBP\>=180 mm Hg DBP \>=110 mm Hg                              |
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| Use of antihypertensive medications before pregnancy Onset of HTN     |
| before the 20^th^ week of gestation                                   |
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| ### Medications                                                       |
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|  ASA 65-85 mg po once a day after 12 weeks GA [Labs]{.underline}:    |
| Baseline -- CBC, Cr, Lytes, AST/ALT, 24 hour urine (pro & CrCl)       |
|                                                                       |
| -   Stop Anti-hypertensives and recheck BP in one week                |
|                                                                       |
| -   If BP 150-160 mm Hg/100-110 mm Hg                                 |
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| restart Alpha-methldopa 250-1000 mg q 8 hours                         |
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| Dose:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_     |
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| [Ultrasound]{.underline} [Monitoring]{.underline} (complete pink      |
| sheet)                                                                |
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| -   18-20 weeks  Kick counts                                         |
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| -   28-32 weeks, then every 4 weeks  At 32 weeks start testing with  |
|     NST/AFI weekly                                                    |
|                                                                       |
|  If IUGR or oligohydramnios increase NST to twice a week             |
|                                                                       |
| [Prenatal visits]{.underline}: Every 4 weeks until 32 weeks, then     |
| every 2 weeks until 36 weeks, then weekly                             |
|                                                                       |
| [Delivery:]{.underline} 38 weeks Date:                                |
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| ## Mild Pre-eclampsia                                                 |
|                                                                       |
| [Definition]{.underline}: SBP [\>]{.underline} 140 mm Hg or DBP       |
| [\>]{.underline} 90 mmHg, upright following a 10 minute rest (should  |
| be repeated in 4-6 hours to confirm dx)                               |
|                                                                       |
| 300 mg of protein in a 24 hour urine specimen (Other methods: 3+ on 2 |
| urine dips 4 hours apart or TP/CR \> 0.2 on CCUA)                     |
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| Consider Hospitalizartion for 48 hours                                |
| Admitted:\_\_\_\_\                                                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
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| See inpatient management guideline                                    |
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| [Monitoring]{.underline} (complete pink sheet) [Labs]{.underline}:    |
|                                                                       |
| -   Kick counts  Baseline -- CBC, Cr, Lytes, AST/ALT, 24 hour urine  |
|     (pro & CrCl)                                                      |
|                                                                       |
| -   NST weekly  If symptomatic - PLt, Cr, BUN, LFTs                  |
|                                                                       |
| -   If IUGR or oligohydramnios                                        |
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|  NST every 3-4 days                                                  |
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|  U/S every 3-4 weeks                                                 |
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| [Prenatal visits]{.underline}: weekly and check BP twice a week       |
|                                                                       |
| [Delivery]{.underline}: 38 weeks                                      |
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| ## Severe Pre-eclampsia (mild plus one or more crtieria)              |
|                                                                       |
| [Definition]{.underline}: SBP [\>]{.underline} 160 mmHg or DBP        |
| [\>]{.underline} 110 mmHg on 2 occasions, 6 hours apart on bedrest    |
|                                                                       |
| Proteinuria 5000 mg in a 24 hour Urine (other method: 3+ or greater   |
| on 2 random urine samples 4 hours apart)                              |
|                                                                       |
| Cerebral or visual changes Epigastric or RUQ pain                     |
|                                                                       |
| Pulmonary edema Oliguria of less than 500 ml in 24 hours              |
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| Impaired liver function IUGR                                          |
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| Thrombocytopenia, platelets \<100,000                                 |
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| ### Plan: Admit for Deliver                                           |
| y. If remote from term consider monitoring as with mild Pre-eclampsia |
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| ## Chronic HTN with superimposed Pre-eclampsia                        |
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| Management for Chronic HTN as outlined above                          |
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| Delivery:                                                             |
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| At or beyond 28 weeks for severe superimposed Pre-eclampsia and HELLP |
| syndrome                                                              |
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| At or beyond 37 weeks for mild superimposed Pre-eclampsia             |
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| ## Gestational HTN                                                    |
|                                                                       |
| [Definition:]{.underline} Blood pressure elevation unaccompanied by   |
| proteinura after 20 weeks                                             |
|                                                                       |
| [Labs]{.underline}: Baseline -- CBC, Cr, Lytes, AST/ALT, 24 hour      |
| urine (pro & CrCl)                                                    |
|                                                                       |
| [Ultrasound]{.underline} [Monitoring]{.underline} (complete pink      |
| sheet)                                                                |
|                                                                       |
| -   18-20 weeks  Kick counts                                         |
|                                                                       |
| -   28-32 weeks, then every 4 weeks  At 32 weeks start testing with  |
|     NST/AFI weekly                                                    |
|                                                                       |
|  If IUGR or oligohydramnios increase NST to twice a week             |
|                                                                       |
| [Prenatal visits]{.underline}: Every 4 weeks until 32 weeks, then     |
| every 2 weeks until 36 weeks, then weekly                             |
|                                                                       |
| [Delivery]{.underline}:                                               |
|                                                                       |
| Without proteinuria deliver at term                                   |
|                                                                       |
| With proteinura deliver at 38 weeks Date:                             |
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  Lab Results                         Ultrasound Results

                                      
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