Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary

Laura A. Magee, Anouk Pels, Michael Helewa, Evelyne Rey, Peter von Dadelszen

Abstract


This executive summary presents in brief the current evidence assessed in the clinical practice guideline prepared by the Canadian Hypertensive Disorders of Pregnancy Working Group and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada to provide a reasonable approach to the diagnosis, evaluation, and treatment of the hypertensive disorders of pregnancy.
Evidence: Published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library in March 2012 using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials, controlled clinical trials, and observational studies published in French or English between January 2006 and February 2012. Searches were updated on a regular basis and incorporated in the guideline to September 2013


Keywords


hypertension; blood pressure; pregnancy; preeclampsia; maternal outcome; perinatal outcome; long-term prognosis

References


Health Canada «Special report on maternal mortality and severe morbidity in Canada. Enhanced surveillance: the path to prevention.» Ottawa: Minister of Public Works and Government Services Canada (2004).

Centre for Maternal and Child Enquiries «Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–08. The eighth report on confidential enquiries into maternal deaths in the United Kingdom.» BJOG,118(Suppl 1) (2011):1-203.

Magee L.A., Pels A., Helewa M., Rey E., Von Dadelszen P. «Canadian Hypertensive Disorders of Pregnancy (HDP) Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy.» Pregnancy Hypertens (2014). Available at: http://www.pregnancyhypertension.org/article/S2210-7789(14)00004-X/fulltext. Accessed on February 28 (2014).

Ogedegbe G., Pickering T. «Principles and techniques of blood pressure measurement.» Cardio Clin, 28(2010):571-86.

Redman C.W.G. «The placenta, pre-eclampsia and chronic villitis. In: Redman CWG, Sargent IL SP, eds. The human placenta.» Oxford: Blackwell Scientific, (1993):433-67.

von Dadelszen P., Payne B., Li J., Ansermino J.M., Broughton Pipkin F., Côté A.M. et al. «PIERS Study Group. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model.» Lancet, 377(9761) (2011):219-27.

Payne B., Magee L.A., Menzies J., Côté A.M., Hutcheon J.A., Kyle P. et al. «PIERS Study Group. PIERS proteinuria: relationship with adverse maternal and perinatal outcome.» J Obstet Gynaecol Can, 33 (2011):588-97.

Lampinen K.H., Rönnback M., Groop P.H., Kaaja R.J. «Renal and vascular function in women with previous preeclampsia: a comparison of lowand high-degree proteinuria.» Kidney Int, 70(2006):1818-22.

Gruslin A., Lemyre B. «Pre-eclampsia: fetal assessment and neonatal outcomes.» Best Pract Res Clinl Obstet Gynaecol, 25(2011):401-507.

Lalor J.G., Fawole B., Alfirevic Z., Devane D. «Biophysical profile for fetal assessment in high risk pregnancies.» Cochrane Database Syst Rev, Jan 23(1) (2008):CD000038.

Kaur S., Picconi J.L., Chadha R., Kruger M., Mari G. «Biophysical profile in the treatment of intrauterine growth-restricted fetuses who weigh <1000 g. Am J Obstet Gynecol, 199(2008):264.e1-4.

Payne B.A., Kyle P.M., Lim K., Lisonkova S., Magee L.A., Pullar B. et al. «An assessment of predictive value of the biophysical profile in women with preeclampsia using data from the full PIERS database.» Pregnancy Hypertens, 3(2013):166-71.

Urquia M.L., Ying I., Glazier R.H., Berger H., De Souza L.R., Ray J.G. «Serious preeclampsia among different immigrant groups.» J Obstet Gynaecol Can, 34(2012):348-52.

Magee L.A., Helewa M., Moutquin J.M., von Dadelszen P. «Hypertension Guideline Committee; Strategic Training Initiative in Research in the Reproductive Health Sciences (STIRRHS) Scholars. SOGC Clinical Practice Guidelines, No. 206, March 2008. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy.» J Obstet Gynaecol Can, 30(3 Suppl 1) (2008):S1-S48.

American College of Obstetricians and Gynecologists «Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy.» Obstet Gynecol, 122(2013):1122-31.

Brown M.A., Lindheimer M.D., de Swiet M., van Assche A., Moutquin J.M. «The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP).» Hypertens Pregnancy, 20(1) (2001):IX-XIV.

Why mothers die 2000–2002 «The sixth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.» London: RCOG Press (2004).

Rey E., Morin F., Boudreault J., Pilon F., Vincent D., Ouellet D. «Blood pressure assessments in different subtypes of hypertensive pregnant women: office versus home patient- or nurse-measured blood pressure.» Hypertens Pregnancy, 28(2009):168-77.

Brown M.A., Mangos G., Davis G., Homer C. «The natural history of white coat hypertension during pregnancy.» BJOG, 112(2005):601-6.

Magee L.A., Ramsay G., von Dadelszen P. «What is the role of out-ofoffice BP measurement in hypertensive pregnancy?» Hypertens Pregnancy, 27(2008):95-101.

Saudan P., Brown M.A., Buddle M.L., Jones M. «Does gestational hypertension become pre-eclampsia?» Br J Obstet Gynaecol, 105(1998):1177-84.

Reinders A., Cuckson A.C., Lee J.T., Shennan A.H. «An accurate automated blood pressure device for use in pregnancy and preeclampsia: the Microlife 3BTO-A.» BJOG, 112(2005):915-20.

Villar J., Say L., Shennan A., Lindheimer M., Duley L., Conde-Agudelo A. et al. «Methodological and technical issues related to the diagnosis, screening, prevention, and treatment of pre-eclampsia and eclampsia.» Int J Gynaecol Obstet, 85(Suppl 1) (2004):S28-S41.

Bellomo G., Narducci P.L., Rondoni F., Pastorelli G., Stangoni G., Angeli G. et al. «Prognostic value of 24-hour blood pressure in pregnancy.» JAMA, 282(1999):1447-52.

Hermida R.C., Ayala D.E., Iglesias M. «Circadian rhythm of blood pressure challenges office values as the «gold standard» in the diagnosis of gestational hypertension.» Chronobiol Int, 20(2003):135-56.

Eguchi Kazuo O., Akihide O., Takako H., Chikako T., Kayo S. et al. «[abstracts of American Society of Hypertension 27th Annual Scientific Meeting and Exposition].» J Clin Hypertens, 14(Suppl 1) (2012):doi: 10.1111/j.1751-7176.2011.00665.x.

Sibai B.M. «Imitators of severe preeclampsia.» Obstet Gynecol, 109(2007):956-66.

Fesenmeier M.F., Coppage K.H., Lambers D.S., BartonJ.R., Sibai B.M. «Acute fatty liver of pregnancy in 3 tertiary care centers.» Am J Obstet Gynecol, 192(2005 0:1416-9.

Erkan D., Espinosa G., Cervera R. «Catastrophic antiphospholipid syndrome: updated diagnostic algorithms.» Autoimmun Rev, 10(2010):74-9.

Martin, J.N, Jr. Bailey A.P., Rehberg J.F., Owens M.T., Keiser S.D., May W.L. «Thrombotic thrombocytopenic purpura in 166 pregnancies: 1955–2006.» Am J Obstet Gynecol, 199(2008):98-104.

Mouthon L., Berezne A., Bussone G., Noel L.H., Villiger P.M., Guillevin L. «Scleroderma renal crisis: a rare but severe complication of systemic sclerosis.» Clin Rev Allergy Immunol, 40(2011):84-91.

Ogge G., Chaiworapongsa T., Romero R., Hussein Y., Kusanovic J.P., Yeo L. et al. «Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia.» J Perinat Med, 39(2011):641-52. doi: 10.1515/JPM.2011.098.

Akolekar R., Syngelaki A., Poon L., Wright D., Nicolaides K.H. «Competing risks model in early screening for preeclampsia by biophysical and biochemical markers.» Fetal Diagn Ther, 33(2013):8-15.

Scazzocchio E., Figueras F., Crispi F., Meler E., Masoller N., Mula R. et al.«Performance of a first-trimester screening of preeclampsia in a routine care lowrisk setting.» Am J Obstet Gynecol, 208(3) (2013):203.e1-203.e10.

Roberts D., Dalziel S.R. «Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.» Cochrane Database of Systematic Reviews,(3)( 2006):CD004454.

Stutchfield P., Whitaker R., Russell I. «Antenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial.» BMJ, 331(2005):662.

Roberts D. «Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality.» Green-top Guideline No. 7. London: Royal College of Obstetricians and Gynaecologists; 2010. Available at: http://www.rcog.org.uk/files/rcog-corp/GTG%207.pdf. Accessed on February 28 (2014).

Shennan A.H., Redman C., Cooper C., Milne F. «Are most maternal deaths from pre-eclampsia avoidable?» Lancet, 379(9827) (2012):1686-7.

Woolf S.H., Battista N., Angerson G.M., Logan A.G., Eel W. «Canadian Task Force on Preventive Health Care.» New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ, 169(2003):207-8.


GOST Style Citations


Health Canada «Special report on maternal mortality and severe morbidity in Canada. Enhanced surveillance: the path to prevention.» Ottawa: Minister of Public Works and Government Services Canada (2004).

Centre for Maternal and Child Enquiries «Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–08. The eighth report on confidential enquiries into maternal deaths in the United Kingdom.» BJOG,118(Suppl 1) (2011):1-203.

Magee L.A., Pels A., Helewa M., Rey E., Von Dadelszen P. «Canadian Hypertensive Disorders of Pregnancy (HDP) Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy.» Pregnancy Hypertens (2014). Available at: http://www.pregnancyhypertension.org/article/S2210-7789(14)00004-X/fulltext. Accessed on February 28 (2014).

Ogedegbe G., Pickering T. «Principles and techniques of blood pressure measurement.» Cardio Clin, 28(2010):571-86.

Redman C.W.G. «The placenta, pre-eclampsia and chronic villitis. In: Redman CWG, Sargent IL SP, eds. The human placenta.» Oxford: Blackwell Scientific, (1993):433-67.

von Dadelszen P., Payne B., Li J., Ansermino J.M., Broughton Pipkin F., Côté A.M. et al. «PIERS Study Group. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model.» Lancet, 377(9761) (2011):219-27.

Payne B., Magee L.A., Menzies J., Côté A.M., Hutcheon J.A., Kyle P. et al. «PIERS Study Group. PIERS proteinuria: relationship with adverse maternal and perinatal outcome.» J Obstet Gynaecol Can, 33 (2011):588-97.

Lampinen K.H., Rönnback M., Groop P.H., Kaaja R.J. «Renal and vascular function in women with previous preeclampsia: a comparison of lowand high-degree proteinuria.» Kidney Int, 70(2006):1818-22.

Gruslin A., Lemyre B. «Pre-eclampsia: fetal assessment and neonatal outcomes.» Best Pract Res Clinl Obstet Gynaecol, 25(2011):401-507.

Lalor J.G., Fawole B., Alfirevic Z., Devane D. «Biophysical profile for fetal assessment in high risk pregnancies.» Cochrane Database Syst Rev, Jan 23(1) (2008):CD000038.

Kaur S., Picconi J.L., Chadha R., Kruger M., Mari G. «Biophysical profile in the treatment of intrauterine growth-restricted fetuses who weigh <1000 g. Am J Obstet Gynecol, 199(2008):264.e1-4.

Payne B.A., Kyle P.M., Lim K., Lisonkova S., Magee L.A., Pullar B. et al. «An assessment of predictive value of the biophysical profile in women with preeclampsia using data from the full PIERS database.» Pregnancy Hypertens, 3(2013):166-71.

Urquia M.L., Ying I., Glazier R.H., Berger H., De Souza L.R., Ray J.G. «Serious preeclampsia among different immigrant groups.» J Obstet Gynaecol Can, 34(2012):348-52.

Magee L.A., Helewa M., Moutquin J.M., von Dadelszen P. «Hypertension Guideline Committee; Strategic Training Initiative in Research in the Reproductive Health Sciences (STIRRHS) Scholars. SOGC Clinical Practice Guidelines, No. 206, March 2008. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy.» J Obstet Gynaecol Can, 30(3 Suppl 1) (2008):S1-S48.

American College of Obstetricians and Gynecologists «Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy.» Obstet Gynecol, 122(2013):1122-31.

Brown M.A., Lindheimer M.D., de Swiet M., van Assche A., Moutquin J.M. «The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP).» Hypertens Pregnancy, 20(1) (2001):IX-XIV.

Why mothers die 2000–2002 «The sixth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.» London: RCOG Press (2004).

Rey E., Morin F., Boudreault J., Pilon F., Vincent D., Ouellet D. «Blood pressure assessments in different subtypes of hypertensive pregnant women: office versus home patient- or nurse-measured blood pressure.» Hypertens Pregnancy, 28(2009):168-77.

Brown M.A., Mangos G., Davis G., Homer C. «The natural history of white coat hypertension during pregnancy.» BJOG, 112(2005):601-6.

Magee L.A., Ramsay G., von Dadelszen P. «What is the role of out-ofoffice BP measurement in hypertensive pregnancy?» Hypertens Pregnancy, 27(2008):95-101.

Saudan P., Brown M.A., Buddle M.L., Jones M. «Does gestational hypertension become pre-eclampsia?» Br J Obstet Gynaecol, 105(1998):1177-84.

Reinders A., Cuckson A.C., Lee J.T., Shennan A.H. «An accurate automated blood pressure device for use in pregnancy and preeclampsia: the Microlife 3BTO-A.» BJOG, 112(2005):915-20. 

Villar J., Say L., Shennan A., Lindheimer M., Duley L., Conde-Agudelo A. et al. «Methodological and technical issues related to the diagnosis, screening, prevention, and treatment of pre-eclampsia and eclampsia.» Int J Gynaecol Obstet, 85(Suppl 1) (2004):S28-S41.

Bellomo G., Narducci P.L., Rondoni F., Pastorelli G., Stangoni G., Angeli G. et al. «Prognostic value of 24-hour blood pressure in pregnancy.» JAMA, 282(1999):1447-52.

Hermida R.C., Ayala D.E., Iglesias M. «Circadian rhythm of blood pressure challenges office values as the «gold standard» in the diagnosis of gestational hypertension.» Chronobiol Int, 20(2003):135-56.

Eguchi Kazuo O., Akihide O., Takako H., Chikako T., Kayo S. et al. «[abstracts of American Society of Hypertension 27th Annual Scientific Meeting and Exposition].» J Clin Hypertens, 14(Suppl 1) (2012):doi: 10.1111/j.1751-7176.2011.00665.x.

Sibai B.M. «Imitators of severe preeclampsia.» Obstet Gynecol, 109(2007):956-66.

Fesenmeier M.F., Coppage K.H., Lambers D.S., BartonJ.R., Sibai B.M. «Acute fatty liver of pregnancy in 3 tertiary care centers.» Am J Obstet Gynecol, 192(2005 0:1416-9.

Erkan D., Espinosa G., Cervera R. «Catastrophic antiphospholipid syndrome: updated diagnostic algorithms.» Autoimmun Rev, 10(2010):74-9.

Martin, J.N, Jr. Bailey A.P., Rehberg J.F., Owens M.T., Keiser S.D., May W.L. «Thrombotic thrombocytopenic purpura in 166 pregnancies: 1955–2006.» Am J Obstet Gynecol, 199(2008):98-104.

Mouthon L., Berezne A., Bussone G., Noel L.H., Villiger P.M., Guillevin L. «Scleroderma renal crisis: a rare but severe complication of systemic sclerosis.» Clin Rev Allergy Immunol, 40(2011):84-91.

Ogge G., Chaiworapongsa T., Romero R., Hussein Y., Kusanovic J.P., Yeo L. et al. «Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia.» J Perinat Med, 39(2011):641-52. doi: 10.1515/JPM.2011.098.

Akolekar R., Syngelaki A., Poon L., Wright D., Nicolaides K.H. «Competing risks model in early screening for preeclampsia by biophysical and biochemical markers.» Fetal Diagn Ther, 33(2013):8-15.

Scazzocchio E., Figueras F., Crispi F., Meler E., Masoller N., Mula R. et al.«Performance of a first-trimester screening of preeclampsia in a routine care lowrisk setting.» Am J Obstet Gynecol, 208(3) (2013):203.e1-203.e10. 

Roberts D., Dalziel S.R. «Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.» Cochrane Database of Systematic Reviews,(3)( 2006):CD004454.

Stutchfield P., Whitaker R., Russell I. «Antenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial.» BMJ, 331(2005):662.

Roberts D. «Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality.» Green-top Guideline No. 7. London: Royal College of Obstetricians and Gynaecologists; 2010. Available at: http://www.rcog.org.uk/files/rcog-corp/GTG%207.pdf. Accessed on February 28 (2014).

Shennan A.H., Redman C., Cooper C., Milne F. «Are most maternal deaths from pre-eclampsia avoidable?» Lancet, 379(9827) (2012):1686-7.

Woolf S.H., Battista N., Angerson G.M., Logan A.G., Eel W. «Canadian Task Force on Preventive Health Care.» New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ, 169(2003):207-8.

 





DOI: http://dx.doi.org/10.18370/2309-4117.2014.18.74-85

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