Department of Obstetrics & Gynecology
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Protocols

 
Subject:      Blood Pressure Assessment
 
Screening /Diagnosis:
 
Hypertensive disorders occur in 6 to 8 percent of pregnancies and contribute significantly to serious complications for both the fetus and the mother. 
 
Measure on left arm in sitting position.  Compare to pre-pregnant blood pressure.  Use appropriate cuff size. If elevated, allow patient to rest for about 15 minutes and retake.  Further investigation is required if:
 
1.      Blood pressure is 140/90 or greater
2.      There is associated proteinuria
 
 
NIH 2000 Working Group Report Classification:
  • Gestational hypertension: elevated blood pressure that first appears during midpregnancy without proteinuria
  • Chronic hypertension: Hypertension that is present and observable before pregnancy or diagnosed before the 20th week of gestation. Nearly one in four hypertensive women will develop preeclampsia during pregnancy, typically during midpregnancy
  • Preeclampsia: Hypertension with proteinuria that develops after the 20th week of gestation.
  • Superimposed preeclampsia - Preeclampsia superimposed upon chronic hypertension.
  • Eclampsia – Preeclampsia with seizures.
Recommendations:       
 
  1. Women having abnormal blood pressures should be monitored very closely and with a medical consultation.
  2. Assess for other signs such as proteinuria, weight gain, etc. that may be related to  preeclampsia.
  3. Patient should be referred if blood pressure is elevated by above screening criteria.
    
Prepared in conjunction with the
Division of Maternal-Fetal Medicine
Duke University Medical Center
 
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                                                           Director
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1/16/07                                                 Date
                                                                
 
References
Blood Pressure
 
1.  American College of Obstetricians and Gynecologists. Hypertension in pregnancy.
     ACOG Tech Bull 1996;219:1-8.
 
2.   Report of the National High Blood Pressure Education Program Working Group
      on High Blood Pressure in Pregnancy. American Journal of Obstetrics and
      Gynecology, Volume 183, Issue 1, July 2000, Pages S1-S22  
 
 
The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.
 
These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.
The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.
 
These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.
 
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