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Treatment
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Severe HTN
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Inpatient care if severe HTN/preeclampsia
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Lower BP to SBP <160 mmHg & DBP <110
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Initial Rx in hospital
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Short-acting nifedipine capsules 5-10 mg po q30 min prn
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Hydralazine 5-10 mg IV q30 min prn
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Labetalol 20-80 mg IV q30 min prn
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Alternatives: NTG infusion, po methyldopa, po labetalol, po clonidine
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Postpartum: po captopril
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Refractory HTN: SNP
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Nifedipine & MgSO4 can be used contemporaneously
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MgSO4 not recommended as sole anti-HTN Rx
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Continuous FHR monitoring until BP stable
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Non-severe (SBP 140-159 mmHg, DBP 90-109 mmHg) w/o comorbid conditions
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Lower BP to SBP 130-155 mmHg & DBP 80-105 mmHg
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Methyldopa 250-500 po bid-qid
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Labetalol 100-400 mg po bid-tid
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Nifedipine XL 20-60 mg po od
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No ACE-Is or ARBs in pregnancy
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Atenolol & prazosin not recommended prior to delivery
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Non-severe w/ comorbid conditions
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Lower BP to SBP <140 mmHg & DBP <90 mmHg
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Same Rx as above
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Captopril, enalapril, or quinapril ok postpartum (even if breastfeeding)
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Adapted from SOGC Clinical Practice Guideline. Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary. J Obstet Gynaecol Can 2014;36(5):416–438
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