Current Best Practices in Managing Hypertensive Pregnancy Disorders

This report addresses the critical need for improved management of hypertensive disorders in pregnancy, including preeclampsia, superimposed preeclampsia, chronic hypertension, and gestational hypertension, to enhance global population health. It differentiates diagnostic criteria, emphasizing the significance of blood pressure measurements and proteinuria assessments. The report outlines management strategies based on proteinuria levels and highlights the importance of early referral for women with chronic hypertension. It references current guidelines, such as ISSHP, for defining preeclampsia and its associated conditions. The report also mentions the importance of fetal monitoring, lifestyle modifications, and patient education. Postnatal counseling for future pregnancies is also highlighted. Finally, the report concludes with a new evolution in prevention, diagnosis and management of preeclampsia have a positive impact in the future practice.

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Hypertensive disorders of pregnancy such as preeclampsia, superimposed preeclampsia, chronic
hypertension and gestational hypertension, needs to be managed more keenly in order to improve
the population health globally. The diagnostic criteria of these disorders vary between gestational
hypertension and preeclampsia and in coming up with the meaning of severe preeclampsia.
Hypertension in pregnancy is a blood pressure of ≥ 140/90 mmHg on at least two measurements
while severe hypertension implies to a blood pressure of ≥ 160-170/110 mmHg. More than
180mmHg systolic pressure is a medical emergency. A delay in obtaining proteinuria (>
300mg/day of total protein) results makes the test substandard for making a quick decision for
admission or delivery in women with preeclampsia. The management of preeclampsia should be
initiated based on proteinuria on dipstick (>2+) when suspicion is more. Women presenting with
proteinuria and no hypertension have to be be monitored for preeclampsia development or any
renal disease.
Any woman presenting at booking may have preexisting hypertension. Ideally, those with
existing hypertension must be given pre-conception counselling and antihypertensive therapy.
Those with chronic hypertension should be referred early to obstetric management, as they
increased the risk of preeclampsia. Most experts now follow the ISSHP to define preeclampsia as
hypertension and any of proteinuria, fetal growth restriction with persistent insufficiencies of the
placenta or organ dysfunction. Others conditions associated with preeclampsia include; HELLP
syndrome, renal impairment, pulmonary edema and cerebral hemorrhage. Preeclampsia,
however, has several differential diagnoses. There are, therefore, new diagnostic tests under
evaluation to provide rapid testing to clarify preeclampsia.
The delivery of placenta leads to resolution of preeclampsia. Therefore, the goals of treatment
include maintaining safe blood pressure, close monitoring of the mother and the fetus. There

should also be proper inpatient/outpatient management, fetal monitoring, lifestyle modification
and patient education and antihypertensives drugs. Timing of the delivery should also be done,
and the women are provided with appropriate intrapartum care and postnatal care. All the women
who had a hypertensive disorder in pregnancy must be given postnatal counselling for
management of future pregnancies. Finally, a new evolution in prevention, diagnosis and
management of preeclampsia have a positive impact in the future practice.

References
Chappell LC, Shennan AH. Assessment of proteinuria in pregnancy. BMJ. 2008;336:968–969.
Thangaratinam S, Coomarasamy A, O’Mahony F, et al. Estimation of proteinuria as a predictor
of complications of preeclampsia: a systematic review. BMC Med. 2009;7(1):10.