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Hypertension in pregnancy - Management
Basis for recommendation
Monitoring and control of blood pressure after the birth
- These recommendations are based on the expert opinion of the National Institute for Health and Clinical Excellence (NICE) [National Collaborating Centre for Women's and Children's Health, 2010].
- NICE identified no evidence about the frequency of postnatal observations or investigations.
- Its recommendations are, therefore, based on the knowledge that blood pressure peaks between 3–5 days after birth, and that it is sensible to monitor blood pressure if changes are made to treatment.
Choice of antihypertensive drug
- NICE identified no evidence about the choice of antihypertensive treatment postpartum. As there is no evidence for any particular antihypertensive, NICE considered that antenatal antihypertensive treatment should continue in the post-natal period unless methyldopa has been used (because of the risk of depression with methyldopa) [National Collaborating Centre for Women's and Children's Health, 2010].
Stopping methyldopa
- NICE is aware of a Medicines and Healthcare products Regulatory Agency (MHRA) report that considers methyldopa to be the drug of choice during pregnancy and breastfeeding [MHRA, 2009]. The MHRA states that methyldopa may not be suitable for some women. However, NICE considers that this drug should not be used during the post-natal period, as women are already at risk of depression, and if possible, it should be stopped and the antihypertensive treatment that the woman was taking before her pregnancy be restarted.
Review of antihypertensive treatment
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