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Home Gynecology and Obstetrics

How to control blood pressure in pregnancy

Dr.Mohamed SabrybyDr.Mohamed Sabry
March 30, 2018
inGynecology and Obstetrics
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How to control blood pressure in pregnancy

How to control blood pressure in pregnancy

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1 How to control blood pressure in pregnancy for chronic hypertension, preeclampsia and superimposed preeclamsia?
2 1. Labetalol ( Control blood pressure in pregnancy ) :
3 2. Nifedipine extended release ( Control blood pressure in pregnancy ) :
4 3. Hydralazine ( Control blood pressure in pregnancy ) :
5 4.Methyldopa ( Control blood pressure in pregnancy ) :

How to control blood pressure in pregnancy for chronic hypertension, preeclampsia and superimposed preeclamsia?

This is the way>>>>

1. Labetalol ( Control blood pressure in pregnancy ) :

Combined alpha- & beta-blocker, 100 mg twice daily, increase by 100 mg twice daily every 2-3 days as needed.
Usual effective dose range is 200-800 mg in 2 divided doses. Maximum total daily dose 2400 mg. In acute situations, give labetalol 20 mg IV over 2 minutes. Repeat BP measurement at 10-minute intervals & if still high give the following doses at the same order after every
10 minutes till controlling BP is established; give 40, 80, 80, 80 mg to achieve a cumulative maximum dose of 300 mg & you can stop at any step once BP is controlled. If still high BP, add nifedipine as mentioned down.
(In my practice; for long-term use, I start 200 mg twice daily & if over controlled
decrease the dose to 100 mg twice daily, but if insufficient to control BP, increase the dose to 200 mg 3 times/daily, then 4 times/day acc. to your needs. As regard acute situations, I can give the IV dosing mentioned up & if not available, I give oral doses instead, in the same way 200 mg once then assess BP at 30 minutes intervals instead of 10 minutes in IV dosing).

How to control blood pressure in pregnancy
How to control blood pressure in pregnancy

2. Nifedipine extended release ( Control blood pressure in pregnancy ) :

Calcium channel blocker, 30-60 mg once daily as an extended release tablet, increase at 7-14 day intervals. Usual effective dose range 30-90 mg/day. Maximum total daily dose 120 mg.
(In my practice; I reserve it for the resistant cases not controlled by labetalol alone i.e if pt on labetalol 200 mg 4 times daily & still BP >145/90, I decrease the labetalol dose to 200 mg 3 times daily & add nifedipine 20 mg 2 times daily & if still high BP, increase the
nifedipine dose to 60 mg sustained release once daily with the 3 times daily labetalol. If BP still high, increase the labetalol dose to 200 mg 4 times daily+nifedipine 60 mg once daily & TERMINATE this case once BP is stabilized even if she is asymptomatic or very early preterm e.g 27 wk only & don’t forget to screen for thrombophilia after delivery 😮 )

3. Hydralazine ( Control blood pressure in pregnancy ) :

Peripheral vasodilator, usually reserved only for acute shooting BP, not for long-term use.
(In my practice, I don’t like it at all even in acute situations as it can cause profound
maternal hypotension & predispose to fetal distress & even IUFD.

4.Methyldopa ( Control blood pressure in pregnancy ) :

Centrally acting alpha-agonist, 250 mg 2-3 times daily, increase every 2 days as needed & take care; the full hypotensive effect of an initial dose or adjustment of
methylodopa may not occur until after 2-3 days of continuous use. Usual effective dose is 250-1000 mg in 2-3 divided doses daily & maximum total daily dose is 3000 mg/daily. (In my practice, I don’t use it dt. weak & slow effect & the extrapyramidal side effects beside it predispose to postpartum depression).
– There is big controversy regarding the target BP & at the end they put the target should be less than 150-130/100-80.
(In my practice, I start small doses once BP reach 145/95)
– For women with complicated or secondary hypertension (eg, target-organ damage as left ventricular hypertrophy, microalbuminuria, retinopathy, dyslipidemia, maternal age >40 years, history of stroke, previous perinatal loss, diabetes), we suggest treatment of HTN,
even if mild (Grade 2C). Our treatment target is systolic pressure 140-120/90-80.

How to control blood pressure in pregnancy

Tags: eclamsiahypertensionpreeclampsiapregnancy
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