妇产科学妊娠性高血压HDP.ppt

Treatment Principle of HDP Rest Dietary Changes Lifestyle Changes Antihypertensive Therapy Eclampsia Prophylaxis or Treatment Therapies for HELLP Syndrome Fetal Pulmonary Maturity Other Therapies Antihypertensive Therapy For Severe Hypertension (BP of > 160 mmHg Systolic or 110 mmHg Diastolic) 1. BP should be lowered to <160 mmHg systolic and <110 mmHg diastolic. (II-2B) 2. Initial antihypertensive therapy should be with labetalol, (I-A) nifedipine capsules, (I-A) nifedipine PA tablets, (I-B) or hydralazine. (I-A) 3. MgSO4 is not recommended as an antihypertensive agent. (I-E) 4. Continuous FHR monitoring is advised until BP is stable. (III-I) 5. Nifedipine and MgSO4 can be used contemporaneously. (II-2B) For Non-Severe Hypertension (BP of 140–159/90–109 mmHg) 1. For women without comorbid conditions, antihypertensive drug therapy should be used to keep sBP at 130–155mmHg and dBP at 80–105 mmHg. (III-C) 2. For women with comorbid conditions, antihypertensive drug therapy should be used to keep sBP at 130–139 mmHg and dBP at 80–89 mmHg. (III-C) 3. Initial therapy can be with one of a variety of antihypertensive agents available in Canada: methyldopa, (I-A) labetalol, (I-A) other beta-blockers (acebutolol, metoprolol, pindolol, and propranolol), (I-B) and calcium channel blockers (nifedipine). (I-A) 4. Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) should not be used. (II-2E) 5. Atenolol and prazosin are not recommended. (I-D) Magnesium Sulphate (MgSO4) for EclampsiaProphylaxis or Treatment 1. MgSO4 is recommended for first-line treatment of eclampsia. (I-A) 2. MgSO4 is recommended as prophylaxis against eclampsia in women with severe preeclampsia. (I-A) 3. MgSO4 may be considered for women with non-severe reeclampsia. (I-C) 4. Phenytoin and benzodiazepines should not be used for eclampsia prophylaxis or treatment, unless there is a contraindication to MgSO4 or it is ineffective. (I-E) Therapies for HELLP Syndrome 1. P