Authors : Bhaska Pal, Parag Biniwale, Hemant Deshpande, Tripura Sundari, Salman Motlekar
DOI : 10.18231/j.ijogr.2019.030
Volume : 6
Issue : 2
Year : 2019
Page No : 122-132
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).