1. Chronic Hypertension Monitoring
Q 3-4 week growth scans starting at viability
If IUGR found, screen with UA doppler as adjunct to antenatal testing
Start antenatal testing if medication needed
If HTN controlled, not recommended to deliver before 38 weeks

2. Chronic Hypertension Treatment
Treat if SBP > 160 or DBP >105
Labetalol, nifedipine, and methyldopa are first line
Thiazides may be continued but should be stopped if preeclampsia
Goal is SBP and DBP
Avoid ACE inhibitor, ARB, mineralocorticoids

3. Gestational Hypertension
Manage like preeclampsia (expectant monitoring and deliver at 37 weeks)

4. Pre-e without severe features
Expectant mangement < 37 weeks
May include:
Weekly labs
Fetal kick counts
Twice/week BP monitoring
Biweekly NST
Weekly AFI
Growth scan q 3-4 weeks
UA dopplers if IUGR present

5. Preeclampsia with Severe Features: MANAGEMENT
Should be hospitalized
Need careful fluid management (monitor urine output, total fluids total fluids restricted to cc/h including mag)
Seizure prevention
Lower BP to prevent end organ damage
Treat when SBP >160 DBP >110
Target /90-100
Delivery expedited taking into account fetal maternal well being and gestation age

6. Magnesium Sulfate for Pre-e or GHTN with severe features
4-6 gm loading dose, then 2 gm/hour
mixed in 100 mL of water, 5% dextrose solution, or 0.9% normal saline intravenously over 15 to 20 minutes
Monitor reflex, mentation, respiratory status and urinary output
Monitor mag levels (4-8 mg/dl is target) if loss of reflexes, concern for kidney function, or other sx
MgSO4 prevents eclamptic seizures (NNT = 100) and placental abruption (NNT = 100) in women who have preeclampsia with severe features

7. Dosing of anti-hypertensives for severe BP
Labetalol
20 mg IV if not effective double to 40 mg and then to 80 mg every 10 minutes
If still high after 80 mg, switch to hydralazine; max dose is 300 mg/24 hrs
Hydralazine
5-10 mg IV over 2 min, if still >160/110 after 20 min  10 mg IV
If still high after 20 min, switch to labetalol
Nifedipine
10 mg PO , if still high after 30 min give 20 mg, if still high after 30 min give another 20 mg
May give mg PO every 4-6 hours

8. Eclampsia Seizures usually last 60-90 seconds
Fetal bradycardia usually recovers
Mg is drug of choice, give 2 gm if already received 4-6 gm bolus
Maintain airway, place on left side, have intubation available
Bed seizure precautions
Avoid immediate c-section for isolated seizure

9. Not recommended to give magnesium to women who do not have severe features
number needed to treat [NNT] = 400 for asymptomatic women with BP less than 160/110 mm Hg, assuming that 50% of seizures are preventable