Detection and Management of Hypertensive Disorders of Pregnancy to Prevent Complications

These conditions can also impact the health of the fetus or newborn and are responsible for up to 13% of stillbirths and 20% of early neonatal deaths in some areas of the world. The World Health Organization (WHO) estimates that 15% of women will have some degree of hypertension during pregnancy. Most cases are benign and do not require treatment or result in complications, but in some cases, the woman has a hypertensive disorder of pregnancy such as pre-eclampsia, which can lead to serious complications or death. Hypertension during pregnancy is classified according to degree of high blood pressure, associated signs and symptoms, and time of onset during pregnancy. Chronic hypertension is high blood pressure detected before the first 20 weeks of gestation, while pregnancy-induced hypertension (PIH) is high blood pressure that begins after 20 weeks of gestation and is not accompanied by protein in the urine. Pre-eclampsia is high blood pressure that begins after 20 weeks of gestation and is accompanied by proteinuria, and may be mild or severe, depending on the degree of high blood pressure or the presence of other signs and symptoms. Eclampsia is a life-threatening condition defined by the presence of convulsions, typically preceded by pre-eclampsia. The Maternal and Neonatal Health (MNH) Program promotes an approach that emphasizes early detection and skilled and timely management of hypertensive disorders of pregnancy to prevent complications. The program recommends focused antenatal care, including evaluation of the woman's blood pressure at every antenatal visit, as the best way to facilitate early detection of hypertensive disorders of pregnancy. Appropriate management of PIH and pre-eclampsia is critical to preventing the complications of pre-eclampsia, and may include close monitoring, health messages and counseling, treatments to prevent convulsions, coma, stroke and other serious complications, and special arrangements for childbirth. Managing severe pre-eclampsia and eclampsia requires immediate and continuous attention at a hospital. Appropriate management may include giving magnesium sulfate to the woman to prevent the occurrence or recurrence of convulsions, controlling the woman's blood pressure using drugs such as hydralazine, labetolol or nifedipine, delivering the baby after the woman's condition is stabilized, regardless of fetal maturity, and monitoring the woman closely to detect and facilitate the management of complications in the renal, hepatic, circulatory, or respiratory systems. The MNH Program is currently working to train and update healthcare providers in the early detection and skilled and timely management of hypertensive disorders of pregnancy. The program is developing global, regional and national standards and guidelines for the detection and management of hypertensive disorders of pregnancy, conducting technical knowledge updates for maternal healthcare providers, trainers and policymakers, conducting training in preservice programs to teach nursing, midwifery and medical students how to detect and manage hypertensive disorders of pregnancy and related complications, and developing job aids that provide critical information on managing or detecting hypertensive disorders of pregnancy in a concise format for easy use in clinical settings. The program also supports social mobilization efforts to educate community members on taking appropriate actions when a woman presents with danger signs of a hypertensive disorder of pregnancy.