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- DOI 10.18231/j.ijogr.2019.030
-
CrossMark
- Citation
Diagnosis, management and care of hypertensive disorders of pregnancy (HDP): An Indian Expert Opinion
- Author Details:
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Bhaska Pal
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Parag Biniwale
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Hemant Deshpande
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Tripura Sundari
-
Salman Motlekar *
Aim: To develop a guiding tool for the screening, diagnosis, management and care of hypertensive disorders of pregnancy (HDP) by Indian expert panel consensus.
Materials and Methods: Databases such as PubMed, Medline, the Cochrane library and Google Scholar were searched for literature on HDP. Guidelines on HDP from Sri- Lanka, Bahrain, Singapore, Malaysia, Federation of Obstetric and Gynecological Societies of India (FOGSI), Japan, Canada, Australia, US, Europe, and others were studied and discussed as reference documents. A 14 member committee of Gynecology and Obstetrics experts was formed in scientific collaboration with Wockhardt Ltd., Mumbai (India) to prepare an expert opinion on HDP for India. The panel discussed hypertension (HTN) for a) classification b) techniques of monitoring BP c) when to start antihypertensive d) diagnostic tests e) important management and type of medical care needed in pre, during and post pregnancy. The panel also compared the guidelines of different countries to discuss the differences and similarities in management of HTN mainly focusing preeclampsia (PE).
Results: The panel recommended NICE guidelines to classify HTN. The panel also advised to follow the antenatal care (ANC) guidelines and perform thorough clinical examination of the patient on first visit preferably in first trimester and then subsequent visits during the pregnancy. The panel emphasized on the measurement of BP with standard mercury sphygmomanometer in the sitting posture. Since PE has a higher incidence in India, a minimum of four antenatal care visits and initial screening (BP and proteinuria) at 8 to 12 weeks of gestation for early diagnosis of hypertension are advised. The panel suggested that the target BP should be 130-150 / 80-100 mm Hg on antihypertensive therapy. Either labetalol or methyldopa should be used as first line treatment during third trimester of pregnancy. However, during second trimester methyldopa should be used as the first line treatment.
Conclusion: This guiding document is an outcome of panel discussions on HDP for Indian women and health care practitioners. It will serve as a guide for obstetricians in India and help them to identify, screen, diagnose and manage women with HDP.
Keywords: Hypertensive disorders of pregnancy (HDP), Pre-eclampsia (PE), Antihypertensive agents, Pregnancy, Postpartum care, Pregnancy induced hypertension (PIH).
References
- Say L CD, Gemmill A,et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014;;2(6):e323-33.
- Balancing the scales: expanding treatment for pregnant women with life-threatening hypertensive conditions in developing countries. A report on barriers and solutions to treat preeclampsia and eclampsia. EngenderHealth. 2007.
- Pre-eclampsia and maternal mortality: global burden. Available at: http://www.pre-eclampsia.org/health- Bhaskar Pal et al. Diagnosis, management and care of hypertensive disorders of pregnancy… Diagnosis, management and care of hypertensive disorders of pregnancy… Indian Journal of Obstetrics and Gynecology Research, April-June, 2019;6(2):122-132 131 information/149-advocacy-awareness/332-pre-eclampsia-and- maternal-mortality-a-global-burden. 2013.
- Duley L. Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean. Br J Obstet Gynaecol 1992;99(7):547-53.
- RCOG: Guideline No: 10 (A)-The Management of severe Pre- eclampsia/ eclampsia.. In: Gyanecologists(RCOG) RCoOa, editor. 2010.
- ICMR.: Assessment of burden of non-communicable diseases in India. Final report of Project WR/SE IND RPC 001 RB 02. SE/02/419575. New Delhi: Indian Council of Medical Research; 2004. 2004.
- Preclampsia Report in National Health Portal. Available at URL: https://www.nhp.gov.in/disease/gynaecology-and- obstetrics/preeclampsia. Last accessed on 9th Feb 2018. 2016.
- Khumanthem PD, Chanam MS, Samjetshabam RD. Maternal mortality and its causes in a tertiary center. J Obstet Gynaecol India 2012;62(2):168-71.
- Konar H, Chakraborty AB. Maternal mortality: a FOGSI study (based on institutional data). J Obstet Gynecol India 2013;63(2):88-95.
- Pal B, Biniwale P, Sundari T. P 4 Diagnosis, management and care of hypertensive disorders of pregnancy (HDP) in India– An Indian Expert Opinion. Pregnancy Hypertens: Int J Women's Cardiovas Health 2017;9:38-9.
- NICE Clinical Guideline: Hypertension in pregnancy the management of hypertensive disorders during pregnancy. In: Excellence NIfHaC, editor. London: Royal College of Obstetricians and Gynaecologists; 2010.
- Hypertension in Pregnancy. Guidelines by ACOG Task Force. Obstetrics and Gynecology. 2013;122(5).
- Guidelines for Antenatal care and skilled attendance at Birth by ANMs/LHVs/SNs. In: Maternal Health Division MoHaW, Govt. of India, editor. India. 2010.
- Duley L, Henderson‐Smart DJ, Chou D. Magnesium sulphate versus phenytoin for eclampsia. The Cochrane Library. 2010.
- Vaisbuch E, Whitty JE, Hassan SS, et al. Circulating angiogenic and antiangiogenic factors in women with eclampsia. Am J Obstet Gynecol 2011;204(2):152. e1-e9.
- Khumanthem PD, Chanam MS, Samjetshabam RD. Maternal mortality and its causes in a tertiary center. J Obstet Gynecol India 2012;62(2):168-71.
- RCOG: Guideline No: 10 (A)-The Management of severe Pre- eclampsia/ eclampsia.. In: Gyanecologists (RCOG) RCoOa, editor.. 2010.
- South Australian Perinatal Practice Guidelines (SAPPG): Hypertensive disorders in pregnancy. In: Department of Health GoSA, editor. South Australia2012.
- Rahul Mehrotra MB, Ravinder S. Sambi, Krishna CK. Hypertension in pregnancy: Challenges and solutions. Indian Heart J 2010;62:423-6.
- Hypertension in Pregnancy (Report of the ACOG Task Force on Hypertension in Pregnancy). Obstet Gynecol 2013;122(5).
- Giuseppe, Grassi G, Parati G, et al. White Coat Hypertension: An Unresolved Diagnostic and Therapeutic Problem. 2015.
- Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Audibert F et al. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014 May 1;36(5):416-38.
- Reem Mustafa A, Anu Gupta, and Rocco C. Venuto. A Comprehensive Review of Hypertension in Pregnancy. J Pregnancy 2012:1-19.
- Mustafa R, Ahmed S, Gupta A. A comprehensive review of hypertension in pregnancy. J Pregnancy. 2012;2012.
- Aukes AM, Wessel I, Dubois AM. Self-reported cognitive functioning in formerly eclamptic women. Am J Obstet Gynecol 2007;197(4):365. e1-e6.
- B. E. Vikse LMI, T. Leivestad, R. Skjærven. Preeclampsia and the risk of end-stage renal disease. England J Med 2008;359:800-9.
- Lowe S, Bowyer L, Lust K. The Management of Hypertensive Disorders of Pregnancy. The recommendations of the Society of Obstetric Medicine of Australia and New Zealand SOMANZ. 2014.
- James PR, Nelson-Piercy C. Management of hypertension before, during, and after pregnancy. Heart 2004;90(12):1499-
- South Australian Perinatal Practice Guidelines (SAPPG): Hypertensive disorders in pregnancy. In: Department of Health GoSA, editor. South Australia. 2012.
- Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183(1):S1-S22.
- Helewa ME, Burrows RF, Smith J. Report of the Canadian Hypertension Society Consensus Conference: 1. Definitions, evaluation and classification of hypertensive disorders in pregnancy. Can Med Assoc J 1997;157(6):715-25.
- Brown M, Hague W, Higgins J. The detection, investigation and management of hypertension in pregnancy: full consensus statement. Aust New Zealand J Obstet Gynaecol 2000;40(2):139-55.
- Abalos E, Duley L, Steyn DW. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. The Cochrane Library. 2007.
- Vyas KM, Vyas AK. The study of role of aspirin and antioxidants in prevention of hypertensive disorders in primigravidas. Int J Biomed Adv Res 2014;5(12):595-9.
- Homer CS, Brown MA, Mangos G. Non-proteinuric pre- eclampsia: a novel risk indicator in women with gestational hypertension. J Hypertens 2008;26(2):295-302.
- Fonseca EB, Celik E, Parra M. Progesterone and the risk of preterm birth among women with a short cervix. England J Med 2007;357(5):462-9.
- Wagner M. What every midwife should know about ACOG and VBAC. Critique of ACOG Practice Bulletin #5, July 1999, "Vaginal birth after previous cesarean section". Midwifery Today Int Midwife 2001(59):41-3.
- Shikha Saxena PCS, K. V. Thimmaraju, Ayaz K. Mallick, Kanchan Dalmia, Biswajit Das. Socio-demographic Profile of Pregnancy Induced Hypertension in a Tertiary Care Centre Scholars. J Appl Med Sci 2014;2(6 (D)):3081-86.
- Sutapa Agrawal GKW. Prevalence and risk factors for Pre- eclampsia in Indian women: a national cross sectional study In: South Asia Network for Chronic Disease PHFoI, New Delhi, India, editor. India2005.
- Ganesh KS, Unnikrishnan B, Nagaraj K. Determinants of Pre- eclampsia: A Case-control Study in a District Hospital in South India. Indian J Community Med 2010;35(4):502-5.
- Zhang J. Partner change, birth interval and risk of pre- eclampsia: a paradoxical triangle. Paediatr Perinat Epidemiol 2007;21(1):31-5.
- Naruse K, Suzuki Y, Nakamoto O, Makino S, Metoki H, Mimura K, Miyake H, Morikawa M, Murayama T, Nohira T, Ohno Y. A Brief Review of the 2009 JSSHP Guidelines for the care and treatment of Pregnancy induced Hypertension. Hypertens Res Pregnancy 2013;1(1):5-7.
- Subhedar V, Inamdar S, Hariharan C. Comparison of efficacy of labetalol and methyldopa in patients with pregnancy- induced hypertension. Int J Reprod Contracept, Obstet Gynecol 2016;2(1):27-34.
- Parmar MT, Solanki HM, Gosalia VV. Study of risk factors of perinatal death in pregnancy induced hypertension (PIH). Natl J Community Med 2012;3(4):703-7.
- Vidhyasagar V. Is Labetalol or Methyldopa a better 1st line antihypertensive drug in the management of hypertension in Bhaskar Pal et al. Diagnosis, management and care of hypertensive disorders of pregnancy… Diagnosis, management and care of hypertensive disorders of pregnancy… Indian Journal of Obstetrics and Gynecology Research, April-June, 2019;6(2):122-132 132 preeclampsia? Available at URL: https://www.researchgate.net/post/Is_Labetalol_or_Methyldop a_a_better_1st_line_antihypertensive_drug_in_the_manageme nt_of_hypertension_in_preeclampsia. Accessed on 2 July
- 2013.
- Sushrut D GA. Labetalol - An Emerging First-line Drug for Pregnancy-induced Hypertension. Indian J Clin Pract 2013;23().
- Lamming G, Pipkin FB, Symonds E. Comparison of the alpha and beta blocking drug, labetalol, and methyl dopa in the treatment of moderate and severe pregnancy-induced hypertension. Clin Exp Hypertens 1980;2(5):865-95.
- Kintiraki E PS, Kotronis G, Goulis DG, Pregnancy-Induced hypertension.. Hormones. 2015;14(2):211-23.
- Rakusan K. Drugs in pregnancy: implications for a cardiologist. Exp Clin Cardiol 2010;15(4):e100.
- Tan LK, de Swiet M. The management of postpartum hypertension. BJOG 2002;109(7):733-6.
- Hypertensive disorders of pregnancy. Aust Prescr 2012. 2012:47–50.
- Singh M, Pathak MS, Paul A. A Study on Atherogenic Indices of Pregnancy Induced Hypertension Patients as Compared to Normal Pregnant Women. J Clin Diagn Res 2015;9(7):BC05-
- Seedat Y, Rayner B. South African hypertension guideline 2011: guideline. S Afr Med J 2012;102(1):60-83.
- National Guidelines for Maternal Care, Srilanka, Colombo, Ministry of Health 2013. Available at URL: file:///C:/Users/admin/Downloads/national_guideline_for_mate rnalcare_1%20(1).pdf. Last accessed on: 21 Feb 2018. 2013.
- Sajith M, Nimbargi V, Modi A, et al. Incidence of pregnancy induced hypertension and prescription pattern of antihypertensive drugs in pregnancy. Int J Pharma Sci Res 2014;23:4.
How to Cite This Article
Vancouver
Pal B, Biniwale P, Deshpande H, Sundari T, Motlekar S. Diagnosis, management and care of hypertensive disorders of pregnancy (HDP): An Indian Expert Opinion [Internet]. Indian J Obstet Gynecol Res. 2019 [cited 2025 Oct 23];6(2):122-132. Available from: https://doi.org/10.18231/j.ijogr.2019.030
APA
Pal, B., Biniwale, P., Deshpande, H., Sundari, T., Motlekar, S. (2019). Diagnosis, management and care of hypertensive disorders of pregnancy (HDP): An Indian Expert Opinion. Indian J Obstet Gynecol Res, 6(2), 122-132. https://doi.org/10.18231/j.ijogr.2019.030
MLA
Pal, Bhaska, Biniwale, Parag, Deshpande, Hemant, Sundari, Tripura, Motlekar, Salman. "Diagnosis, management and care of hypertensive disorders of pregnancy (HDP): An Indian Expert Opinion." Indian J Obstet Gynecol Res, vol. 6, no. 2, 2019, pp. 122-132. https://doi.org/10.18231/j.ijogr.2019.030
Chicago
Pal, B., Biniwale, P., Deshpande, H., Sundari, T., Motlekar, S.. "Diagnosis, management and care of hypertensive disorders of pregnancy (HDP): An Indian Expert Opinion." Indian J Obstet Gynecol Res 6, no. 2 (2019): 122-132. https://doi.org/10.18231/j.ijogr.2019.030