INVESTIGATIONS & DIAGNOSIS, REFERRAL CRITERIA & TREATMENT PLAN

INVESTIGATIONS & DIAGNOSIS 

For preeclampsia:

• If Urine dipstick: +1 protein, test for:
• Urine ACR >8mg
• Urine PCR >30mg

REFERRAL CRITERIA 

• pregnancy + hypertension: specialist referral
• pregnancy + hypertension @ 20 weeks: same-day assessment
• pregnancy + hypertension of 160/110: urgent same-day assessment

TREATMENT PLAN 

Antihypertensive medications (treatment starts from >140/90):

1. First line: Labetalol
2. Second line: Nifedipine
3. Third line: Methyldopa (stop within 2 days postpartum all switched to another antihypertensive due to risk of depression)

Severe HTN (Bp >160/110)

• Admit for IV/PO labetalol/ IV hydralazine/ PO nifedipine

Severe Pre-eclampsia:

• IV Mg Sulphate
• may need early induced birth – give antenatal corticosteroids to help with lung maturation.

Contraindicated HTN meds in pregnancy:

• ACE inhibitors
• ARBs
• Thiazide diuretics

Postpartum management:

• On medication: review within 2 weeks – No medication: review 6-8 weeks
• BP >150/90: continue/start medication
• BP <140/90: Blood pressure aim !! Consider reducing/stopping medication at this point. – BP <130/80: consider stopping medication

Breastfeeding medications:

• Enalapril (preferred, especially for breastfeeding Imported to monitor U&e’s)
• Amlodipine Preferred first-line 1^st line antihypertensive medication for Africans – Nifedipine – If the above treatment does not work, you can combine medications from above.

Furthermore, you can also consider adding Labetalol or Atenolol.

if there are no breastfeeding plans, treat hypertension like you would treat any normal individual.

KEY INFORMATION 

• Regular BP monitoring essential
• Medication adjustment based on postpartum BP readings.

HTN in Pregnancy Reference

                   Figure 1