Treatment

  • Severe HTN

    • Inpatient care if severe HTN/preeclampsia

    • Lower BP to SBP <160 mmHg & DBP <110

      • Initial Rx in hospital

        • Short-acting nifedipine capsules 5-10 mg po q30 min prn

        • Hydralazine 5-10 mg IV q30 min prn

        • Labetalol 20-80 mg IV q30 min prn

      • Alternatives: NTG infusion, po methyldopa, po labetalol, po clonidine

        • Postpartum: po captopril

      • Refractory HTN: SNP

      • Nifedipine & MgSO4 can be used contemporaneously

      • MgSO4 not recommended as sole anti-HTN Rx

    • Continuous FHR monitoring until BP stable

  • Non-severe (SBP 140-159 mmHg, DBP 90-109 mmHg) w/o comorbid conditions

    • Lower BP to SBP 130-155 mmHg & DBP 80-105 mmHg

      • Methyldopa 250-500 po bid-qid

      • Labetalol 100-400 mg po bid-tid

      • Nifedipine XL 20-60 mg po od

    • No ACE-Is or ARBs in pregnancy

    • Atenolol & prazosin not recommended prior to delivery

  • Non-severe  w/ comorbid conditions

    • Lower BP to SBP <140 mmHg & DBP <90 mmHg

      • Same Rx as above

    • Captopril, enalapril, or quinapril ok postpartum (even if breastfeeding)

 

 

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