Management of Hypertension During Labor

Assessment and Monitoring

Hypertensive disorders in pregnancy complicate 5-10% of pregnancies and are a major cause of maternal, fetal, and neonatal morbidity and mortality 1
All pre-eclamptic women should be hospitalized and closely monitored in obstetric care centers with adequate maternal and neonatal intensive care resources 3
Monitor for early maternal warning signs including high blood pressure, rapid heart rate, and decreased urine output, which should trigger proper diagnostic workup and treatment 2
Evaluate for signs of end-organ damage: headache, visual disturbances, chest pain, difficulty breathing, neurological symptoms, abdominal pain, and altered mental status 4

Blood pressure ≥160/110 mmHg lasting >15 minutes warrants immediate drug treatment regardless of delivery plans 1, 5
The immediate goal is to decrease mean blood pressure by 15-25% with a target systolic blood pressure of 140-150 mmHg and diastolic blood pressure of 90-100 mmHg 4
First-line treatments include labetalol IV and oral nifedipine 1, 4, 5

Antihypertensive treatment should be continued during labor and delivery 5
Magnesium sulfate is recommended for the prevention of eclampsia and treatment of seizures 1
Caution: Magnesium sulfate should not be given concomitantly with calcium channel blockers due to risk of low blood pressure from potential synergism 1, 3

Ten percent of maternal deaths due to hypertensive disorders in pregnancy occur in the postpartum period 3
Continue monitoring blood pressure closely after delivery 5
Transition to oral antihypertensive medications compatible with breastfeeding once blood pressure is controlled 4
Safe options for breastfeeding mothers include labetalol, nifedipine, and metoprolol 1
All women with hypertension in pregnancy should have blood pressure and urine checked at 6 weeks postpartum 4

Women with pregnancy-related hypertensive disorders are at increased risk of developing high blood pressure, stroke, heart disease, and blood clots later in life 4
Cardiovascular risk assessment and lifestyle modifications are recommended for all women with a pregnancy-related hypertensive disorder 4