Drugs for treatment of very high blood pressure during pregnancy
RHL practical aspects by Oladapo OT and Adetoro O
FIRST CONTACT (PRIMARY CARE LEVEL)
Service providers at this level have a dual role. First, they must be alert to recognize high blood pressure in pregnancy (> 140/90 mm Hg) for prompt referral. Second, they should undertake education campaigns to teach women about the symptoms suggestive of very high blood pressure during pregnancy e.g. headache, blurring of vision, epigastric pain and palpitations. This would help to ensure that pregnant women seek timely antenatal care.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
At this level, the health-care provider must be knowledgeable about the drugs that can quickly reduce very high blood pressure in pregnancy. In cases where the response to antihypertensive agent(s) is less than satisfactory, immediate delivery should be considered in order to reduce the complications of very high blood pressure for the mother and fetus. Update courses must be organized regularly for health-care providers to promote a better understanding of current drug usage. Individual institution should formulate standardized protocols based on their experience with available antihypertensive drugs for the care of pregnant women with severe hypertension. Calcium channel blockers should not be the first drug of choice for controlling high blood pressure in women who might require magnesium sulfate for the prevention of fits.
AT HOME OR IN THE COMMUNITY
Community health workers should be encouraged to visit pregnant women regularly in their homes as a form of community antenatal care. Women in the community should be interviewed for possible symptoms of severe hypertension in pregnancy. Once a case is suspected, the patient should be referred to a primary health-care centre for assessment before referral to the secondary level.
This document should be cited as: Olufemi OT and Adetoro O. Oladapo. Drugs for treatment of very high blood pressure during pregnancy: RHL practical aspects (last revised: 15 December 2006). The WHO Reproductive Health Library; Geneva: World Health Organization.