Neftaly Management of Hypertensive Disorders in Pregnancy

1. Introduction

Hypertensive disorders are among the leading causes of maternal and perinatal morbidity and mortality globally. Timely detection and appropriate management are crucial to saving the lives of both mothers and babies.

Neftaly is committed to improving maternal health outcomes by equipping healthcare providers with standardized, evidence-based protocols for identifying, managing, and preventing complications associated with hypertensive disorders during pregnancy.

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2. Objectives

• Improve early detection of hypertensive disorders during pregnancy.
• Standardize clinical management at all levels of care.
• Reduce maternal and neonatal mortality associated with complications.
• Promote referral systems and emergency preparedness.
• Empower communities with awareness and education.

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3. Classification of Hypertensive Disorders in Pregnancy

Condition	Definition
Gestational Hypertension	New-onset hypertension after 20 weeks of gestation without proteinuria or signs of organ damage.
Chronic Hypertension	Hypertension diagnosed before pregnancy or before 20 weeks of gestation.
Preeclampsia	Hypertension after 20 weeks of gestation with proteinuria and/or signs of end-organ dysfunction.
Eclampsia	Preeclampsia with the onset of seizures not attributable to other causes.
Superimposed Preeclampsia	Chronic hypertension with new-onset proteinuria or other features of preeclampsia after 20 weeks.

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4. Screening and Diagnosis

4.1 Routine Antenatal Screening

• Check blood pressure at every ANC visit.
• Screen for proteinuria using dipsticks or urine analysis.
• Monitor for signs: headaches, blurred vision, right upper quadrant pain, swelling of face/hands.

4.2 Diagnostic Criteria

Condition	Criteria
Hypertension	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg (measured twice, 4–6 hours apart)
Severe Hypertension	SBP ≥ 160 mmHg or DBP ≥ 110 mmHg
Proteinuria	≥ 300 mg/24h or ≥ +1 on dipstick
Severe Features	Elevated liver enzymes, low platelets, renal dysfunction, pulmonary edema, visual disturbances

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5. Management Protocols

5.1 Gestational and Chronic Hypertension (No Severe Features)

• Monitor: BP every 1–2 weeks, urine protein, fetal growth.
• Medication: Methyldopa, labetalol, or nifedipine as first-line options.
• Delivery: Plan delivery at 37–39 weeks if stable.

5.2 Preeclampsia Without Severe Features

• Monitoring: Twice weekly BP and labs (LFTs, CBC, renal function).
• Medication: Antihypertensives to maintain BP < 150/100 mmHg.
• Fetal Surveillance: NST, ultrasound for growth and amniotic fluid.
• Delivery: At 37 weeks or earlier if deterioration occurs.

5.3 Preeclampsia With Severe Features

• Admission to hospital.
• Control BP: Rapid-acting agents (IV labetalol, hydralazine).
• Seizure prophylaxis: Magnesium sulfate (loading and maintenance doses).
• Labs: LFTs, platelets, renal function every 1–2 days.
• Fetal assessment: Continuous monitoring if viable.
• Delivery: Immediate if gestational age ≥34 weeks or if maternal/fetal condition worsens.

5.4 Eclampsia

• Emergency care required.
• Airway and seizure control: Magnesium sulfate is first-line.
• BP management: As above.
• Delivery: Once the mother is stabilized — regardless of gestational age.
• Postpartum care: Continue magnesium sulfate for 24 hours post last seizure.

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6. Magnesium Sulfate Protocol

Loading dose:

• 4g IV over 15–20 minutes
• PLUS 10g IM (5g in each buttock)

Maintenance dose:

• 5g IM every 4 hours OR
• 1–2g/hour IV infusion

Monitor for toxicity:

• Check reflexes, respiratory rate (>12/min), urine output (>25ml/hr)
• Antidote: Calcium gluconate 10% IV 10ml over 10 minutes

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7. Postpartum Management

• Continue antihypertensives as needed.
• Monitor BP for 72 hours post-delivery and at 7–10 days postpartum.
• Educate about risk of future cardiovascular disease and preeclampsia.
• Schedule follow-up at 6 weeks postpartum.

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8. Referral and Emergency Preparedness

• Immediate referral for:
  • Severe hypertension or eclampsia
  • Signs of maternal or fetal compromise
  • Uncontrolled BP or deteriorating labs
• Ensure availability of:
  • Transport and referral protocols
  • Emergency kits (antihypertensives, magnesium sulfate, IV supplies)
  • Stabilization before transfer

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9. Community Awareness and Education

Neftaly trains Community Health Workers to:

• Educate pregnant women on warning signs of high blood pressure.
• Promote early ANC registration.
• Support medication adherence and follow-up.
• Facilitate timely referrals.

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10. Data and Monitoring

• Record blood pressure and symptoms at every contact.
• Track maternal outcomes: seizures, ICU admission, perinatal outcomes.
• Use digital tools or ANC registers for tracking high-risk pregnancies.
• Report severe preeclampsia/eclampsia cases to Neftaly’s Maternity Surveillance Unit.

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11. Training and Capacity Building

Neftaly supports:

• On-site and remote training for nurses, midwives, and doctors.
• Emergency drills and simulation training.
• Protocol checklists and decision-support tools.
• Supervision and mentorship visits.

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12. Conclusion

Hypertensive disorders in pregnancy require vigilant monitoring, prompt management, and a coordinated care approach. Neftaly’s comprehensive strategy ensures that pregnant women receive timely, respectful, and life-saving care — protecting both mother and baby from preventable complications.

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For clinical tools, training materials, or technical support, contact the Neftaly Maternal Health Team.