From the Guidelines
Pregnancy termination should be considered in cases of severe hypertension, typically defined as blood pressure ≥160/110 mmHg, when it poses significant risks to maternal health, particularly if associated with preeclampsia with severe features that is refractory to treatment, as stated in the 2020 position paper by the ESC Council on Hypertension and the European Society of Hypertension 1. When managing hypertension in pregnancy, it is crucial to balance maternal risks against fetal viability and gestational age.
- Severe pre-eclampsia requires prompt delivery, either vaginally or by caesarean section, regardless of gestational age, to prevent maternal and fetal complications.
- Antihypertensive treatment should be continued during labor and delivery to keep systolic blood pressure (SBP) < 160 mmHg and diastolic blood pressure (DBP) < 110 mmHg, as recommended by the European Heart Journal study 1. Key considerations in the management of severe hypertension in pregnancy include:
- Aggressive blood pressure management with medications such as labetalol, hydralazine, or nifedipine.
- Administration of magnesium sulfate for seizure prophylaxis in severe preeclampsia.
- Evaluation of fetal viability and gestational age to determine the best course of action.
- Consideration of corticosteroids for fetal lung maturity if time permits before delivery becomes necessary for maternal indications. In real-life clinical practice, the decision to terminate pregnancy due to severe hypertension must be made on a case-by-case basis, taking into account the individual patient's circumstances and the potential risks and benefits of continuing the pregnancy versus terminating it, as guided by the most recent and highest quality evidence available, such as the 2020 position paper by the ESC Council on Hypertension and the European Society of Hypertension 1.
From the Research
Blood Pressure Indication for Pregnancy Termination
- The decision to terminate a pregnancy due to hypertension is typically considered when blood pressure control is not achieved with medical treatment, particularly in cases of severe hypertension 2.
- Severe hypertension in pregnancy is generally defined as a systolic blood pressure of 160 mmHg or higher, or a diastolic blood pressure of 110 mmHg or higher 3, 4, 5.
- In viable pregnancies, delivery is often indicated when blood pressure control is not achieved with three drugs in full doses 2.
- The management of resistant hypertension in pregnancy must consider the possible etiology, fetal well-being, and the mother's risk, with the goal of reducing maternal mortality risk 2.
Treatment of Severe Hypertension in Pregnancy
- Oral antihypertensive medications such as methyldopa, labetalol, and nifedipine are commonly used to treat severe hypertension in pregnancy 3, 6, 5.
- Immediate release oral nifedipine is often used to treat severe hypertension episodes, with a goal of achieving target blood pressure within 60 minutes 4.
- Appropriate antihypertensive administration is crucial in managing severe hypertension, with a focus on reducing maternal morbidity and mortality 4.