Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Emergency Obstectric Care
Hypertension in Pregnancy
Hypertension
Assessment and management
Delivery
Postpartum care
Chronic hypertension
Complications
Management of Slow Progress of Labour
General principles
Slow progress of labour
Progress of labour
Operative procedures
Bleeding in Pregnancy and Childbirth
Bleeding
Diagnosis and initial management
Specific management
Procedures
Aftercare and follow-up
Hypertension
 




Encourage additional periods of rest.

High levels of blood pressure maintain renal and placental perfusion in chronic hypertension; reducing blood pressure will result in diminished perfusion. Blood pressure should not be lowered below its pre-pregnancy level. There is no evidence that aggressive treatment to lower the blood pressure to normal levels improves either fetal or maternal outcome:

:: If the woman was on antihypertensive medication before pregnancy and the disease is well controlled, continue the same medication if acceptable in pregnancy
:: If diastolic blood pressure is 110 mmHg or more, or systolic blood pressure is 160 mmHg or more, treat with antihypertensive drugs: e.g. methyldopa
:: If proteinuria or other signs and symptoms are present, consider superimposed pre-eclampsia and manage as pre-eclampsia
:: Monitor fetal growth and condition
:: If there are no complications, deliver at term
:: If there are fetal heart rate abnormalities (less than 100 or more than 180 beats per minute), suspect fetal distress
:: If fetal growth restriction is severe and pregnancy dating is accurate, assess the cervix and consider delivery
:: If the cervix is favourable (soft, thin, partially dilated) rupture the membranes with an amniotic hook or a Kocher clamp and induce labour using oxytocin or prostaglandins
:: If the cervix is unfavourable (firm, thick, closed), ripen the cervix using prostaglandins or Foley catheter
:: Observe for complications including abruptio placentae and super-imposed pre-eclampsia.

 



Top of Page