Management of Hypertensive Crisis for the Obstetrician/Gynecologist

Special Considerations for Primary and Secondary Stroke Prevention in Women

“…Severe hypertension (SBP 160 mm Hg or DBP 110 mm Hg) during pregnancy and the puerperium is an emergency and requires immediate and prompt evaluation and treatment to avoid maternal and fetal morbidity and mortality. 4,9 The available data, extrapolating from nonpregnant patients, recommend parenteral therapy and monitoring with an arterial line to lower mean arterial BP by no more than 25% over minutes to hours, and then further lowering to 160/100 mm Hg over hours. 8 Magnesium sulfate for seizure prophylaxis reduced the risk of eclampsia in women with pre-eclampsia and is recommended.…”

“…4,10 Antihypertensive Therapy during Pregnancy First-line oral antihypertensive agents for blood pressure control include methyldopa, β-blockers (labetalol, acebutolol, metoprolol, pindolol, and propranolol), and calcium channel blockers (nifedipine). 8,9 Second-line therapies include thiazide diuretics. 9 Acute management in the setting of severe hypertension can be achieved with intravenous labetalol, hydralazine, and oral nifedipine as first-line agents.…”

“…8,9 Second-line therapies include thiazide diuretics. 9 Acute management in the setting of severe hypertension can be achieved with intravenous labetalol, hydralazine, and oral nifedipine as first-line agents. Second-line therapy includes esmolol, nicardipine, and or nitroprusside.…”

“…Second-line therapy includes esmolol, nicardipine, and or nitroprusside. 8,9 Parenteral hydralazine is associated with maternal hypotension, caesarean delivery, and adverse effects on fetal heart rate; it was less effective than calcium channel blockers, but more effective than labetalol. Labetalol is associated with neonatal bradycardia.…”

Hypertensive disorders in pregnancy

“…Methyldopa may also be used (1). Hypertensive emergencies should be treated with intravenous labetalol, oral nifedipine, or intravenous hydralazine (1,25) or with intravenous sodium nitroprusside (24). Sodium nitroprusside should be used only in extreme emergencies and used for the shortest amount of time possible because of cyanide and thiocyanate toxicity in the mother and fetus or newborn and increased intracranial pressure in the mother (26).…”