1. MANAGEMENT OF
POST-PARTUM
HYPERTENSION
O&G Updates 2014
Hospital Sarikei
yongsoonleong@yahoo.com

2. Scopes
O Who are at risk?
O When to treat?
O How to treat?
O What are the choices of treatment?
O How to follow up?

3. Who are at risk?
Smith et.al. Management of Postpartum Hypertension. TOG; 2013.

4. When to treat?
Up to 44% of
eclampsia occur
within 48 hours
postnatally
Delay
discharge
PET patients
till day 3
Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ
1994;309:1395–400.

5. When to treat?
BP ≥ 150/100 mmHg
Prevent Cerebral
Haemorrhage
Smith et.al. Management of Postpartum Hypertension. TOG; 2013.

6. How to treat?
O Criteria of IDEAL anti-hypertensive agent
to be used in the postnatal period
 Effectively control BP without diurnal peak
& troughs
 Minimal maternal side effects
 Safe for breast-feeding
 Preferably once-daily dosing

7. What are the choices of treatment?
(acute hypertensive crisis – IV/Oral)
Antenatal Postnatal
Hydralazine
Labetalol
Nifedipine
Hydralazine
Labetalol
Nifedipine

8. What are the choices of treatment?
(ongoing postnatal hypertension – oral treatment)
Antenatal Postnatal
**Methyldopa
Should be discontinued postnatally
due to its maternal side effect
(sedation, postural hypotension,
postnatal depression)
tds
od
bd
tds

9. What are the choices of treatment?
(breast-feeding safety)
NICE. Hypertension in Pregnancy. The Management of
Hypertension Disorders in Pregnancy. London: NICE; 2010.

10. How to follow up?
O EOD BP check for 2 weeks.
O Medication should be reduced when BP is 130-
140/80-90 mmHg.
O Refer doctor if 2x BP of >150/100mmHg at 20
minutes interval.
O Hospital admission if
 symptoms of pre-eclampsia, or
 BP > 160/100 mmHg
O If medication is required beyond 6 weeks, need to
assess secondary cause of hypertension.

11. How to follow up?
NICE. Hypertension in Pregnancy. The Management of
Hypertension Disorders in Pregnancy. London: NICE; 2010.

12. THANKS