{"id":14298,"date":"2023-03-07T14:49:55","date_gmt":"2023-03-07T14:49:55","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=14298"},"modified":"2024-12-27T14:06:40","modified_gmt":"2024-12-27T14:06:40","slug":"postnatal-hypertension-2","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/pregnancy\/postnatal-hypertension-2\/","title":{"rendered":"Postnatal Hypertension"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Hypertension in the postnatal period<\/strong><strong><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Information<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hypertensive disorders during pregnancy affect around 8-10% of all pregnant women and can be associated with substantial complications for the woman and the baby including maternal morbidity, stillbirths, neonatal deaths and perinatal morbidity. Women with hypertension in pregnancy are also at increased risk of CVS disease in later life. Up to 40% of hypertensive disorders of pregnancy can emerge in the early postnatal period.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>M.A. &amp; K.H. 07-03-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who can refer<\/strong>:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><em>GP<\/em><\/li>\n\n\n\n<li><em>Community midwife<\/em><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Consider the possibility of pre-eclampsia or eclampsia in the postnatal period if a woman develops any of the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Severe headaches, increasing frequency, unrelieved by analgesia<\/li>\n\n\n\n<li>Visual problems<\/li>\n\n\n\n<li>Persistent new epigastric or RUQ pain<\/li>\n\n\n\n<li>Vomiting<\/li>\n\n\n\n<li>Hypertension &gt;140\/90<\/li>\n\n\n\n<li>Proteinuria<\/li>\n\n\n\n<li>Sudden onset SOB due to pulmonary oedema<\/li>\n\n\n\n<li>Sudden swelling of hands, face or feet<\/li>\n\n\n\n<li>Seizure within 4 weeks of birth<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>If concerns about pre-eclampsia or very high BP (160\/110mHg) \u2013 urgent referral to Obstetric Triage Assessment at Royal Infirmary (0131 242 2657) or labour ward at St John\u2019s Hospital (01506 524125), or contact the Obstetric Registrar On Call via Switchboard at Royal Infirmary \/ St John\u2019s Hospital.<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><em>For emergencies and urgent care, patients can come without calling.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>However, if possible, the patient should phone for advice first. There is a midwife who is available 24\/7:<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Royal Infirmary of Edinburgh 0131 242 2657<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>St John\u2019s Hospital 01506 524125<\/em><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>For women with existing hypertension<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Suggested monitoring<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Daily for the first 2 days after birth, once between days 3-4, then as clinically indicated<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">thereafter, usually every other day for 2 weeks. This can be completed by the community midwives.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Suggested treatment<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Continue antihypertensives<\/li>\n\n\n\n<li>Methyldopa should have been stopped after birth<\/li>\n\n\n\n<li>Restart antihypertensive treatment from before pregnancy unless breast feeding<\/li>\n\n\n\n<li>Medical review at 6-8 weeks<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>For women with gestational hypertension<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Suggested monitoring<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Daily for the first 2 days after birth, once between days 3-4, then as clinically indicated<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">thereafter. This can be completed by the community midwives.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Suggested treatment<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>For women discharged on antihypertensives &#8211; continue medications, monitor BP as above and reduce doses as required<\/li>\n\n\n\n<li>Duration will usually be similar to duration of antenatal treatment but may be longer<\/li>\n\n\n\n<li>Medical review 2 weeks after transfer to community care and at 6-8 weeks<\/li>\n\n\n\n<li>Target BP is 140\/90<\/li>\n\n\n\n<li>If gestational hypertension not on treatment, consider initiation of treatment if BP &gt;140\/90, Review at 6 weeks if gestational hypertension not on treatment<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Postnatal hypertension<\/strong><strong><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Blood pressure peaks days 3-6 postnatal and BP should be checked postnatally to identify late pre-eclampsia. This can be completed by the community midwives.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Suggested monitoring<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Daily for the first 2 days after birth, once between days 3-4, then as clinically indicated thereafter.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Suggested treatment<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Aim &lt;140\/90. If BP &gt;140\/90 &#8211; consider commencing antihypertensive &#8211; see table below if breastfeeding<\/li>\n\n\n\n<li>If not breastfeeding postnatally &#8211; manage as per NICE guideline for hypertension in adults.<\/li>\n\n\n\n<li>If BP &gt;160\/110 or symptomatic &#8211; refer to Obs Triage for urgent assessment<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-full\"><div class=\"wpcp-wp-lightbox-host wpcp-advanced-image-lightbox-icon-hover\"><a class=\"wpcp-wp-lightbox-image-link\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Postnatal-Hypertension.png\" data-wpcp-wp-lb-image=\"1\"><img loading=\"lazy\" decoding=\"async\" width=\"953\" height=\"744\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Postnatal-Hypertension.png\" alt=\"Postnatal Hypertension\" class=\"wp-image-14299\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Postnatal-Hypertension.png 953w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Postnatal-Hypertension-300x234.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Postnatal-Hypertension-768x600.png 768w\" sizes=\"auto, (max-width: 953px) 100vw, 953px\" \/><\/a><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Postnatal-Hypertension.png\" data-fancybox=\"wpcp-wp-img-14299\" class=\"wpcp-lightbox-trigger wpcp-advanced-image-lightbox-icon wpcp-position-top-right wpcp-advanced-image-lightbox-icon-hover wpcp-global-lightbox-icon wpcp-lightbox-icon--global wpcp-lb-icon-style-default\" data-wpcp-lb-icon-source=\"global\" aria-label=\"Open image in lightbox\" data-thumb-src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Postnatal-Hypertension-300x234.png\" data-wpcp-lb-single=\"1\"><span class=\"wpcp-icon-container\"><svg viewBox=\"0 0 20 20\"><path d=\"M17.6585 16.025L14.2437 12.6198C15.1716 11.3338 15.6121 9.7613 15.4871 8.1819C15.362 6.60251 14.6795 5.11847 13.5607 3.99351C12.936 3.36206 12.1916 2.86066 11.3709 2.51845C10.5502 2.17623 9.66952 2 8.77995 2C7.89039 2 7.00969 2.17623 6.18899 2.51845C5.36829 2.86066 4.62395 3.36206 3.99919 3.99351C3.36594 4.61649 2.86312 5.35871 2.51992 6.17708C2.17673 6.99545 2 7.87365 2 8.76068C2 9.64772 2.17673 10.5259 2.51992 11.3443C2.86312 12.1627 3.36594 12.9049 3.99919 13.5279C5.11957 14.6901 6.62279 15.4103 8.23285 15.5562C9.84291 15.7022 11.4517 15.2641 12.7639 14.3224L16.1788 17.7275C16.3849 17.9034 16.6473 18 16.9186 18C17.1899 18 17.4523 17.9034 17.6585 17.7275C18.1138 17.16 18.1138 16.5925 17.6585 16.025ZM5.59278 12.0523C5.16258 11.6298 4.82094 11.1263 4.58774 10.5709C4.35455 10.0156 4.23446 9.41951 4.23446 8.81744C4.23446 8.21536 4.35455 7.6193 4.58774 7.06394C4.82094 6.50859 5.16258 6.00503 5.59278 5.58257C6.01644 5.15359 6.52144 4.81292 7.07838 4.58039C7.63532 4.34786 8.23308 4.22811 8.83687 4.22811C9.44066 4.22811 10.0384 4.34786 10.5954 4.58039C11.1523 4.81292 11.6573 5.15359 12.081 5.58257C12.5112 6.00503 12.8528 6.50859 13.086 7.06394C13.3192 7.6193 13.4393 8.21536 13.4393 8.81744C13.4393 9.41951 13.3192 10.0156 13.086 10.5709C12.8528 11.1263 12.5112 11.6298 12.081 12.0523C11.6573 12.4813 11.1523 12.822 10.5954 13.0545C10.0384 13.287 9.44066 13.4068 8.83687 13.4068C8.23308 13.4068 7.63532 13.287 7.07838 13.0545C6.52144 12.822 6.01644 12.4813 5.59278 12.0523Z\" \/><\/svg><\/span><\/a><\/div><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Ongoing Follow Up<\/strong><strong><\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>All patients should have a repeat urine dipstick for protein at 6 weeks, if not resolved please send urine PCR and for further review at 3 months. If ongoing proteinuria or abnormal renal function consider referral to renal physician as appropriate<\/li>\n\n\n\n<li>If hypertensive and &lt;40 &#8211; for investigation for secondary cause as per guidelines<\/li>\n\n\n\n<li>If hypertensive and &gt;40 &#8211; for management as new adult essential hypertension<\/li>\n\n\n\n<li>Women with pregnancy induced hypertension in the long term have high rates of chronic hypertension, cardiovascular disease and thromboembolism.<\/li>\n\n\n\n<li>Consider using ASSIGN or QRISK in women over 30 who have had hypertension during pregnancy, even if resolved following delivery.<\/li>\n\n\n\n<li>Life style changes &#8211; Smoking cessation, weight management, low salt diet and regular exercise encouraged.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Antenatal Hypertension medication recommendations used in NHS Lothian<\/strong><strong><\/strong><\/h4>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Drug<\/strong><\/td><td><strong>Place in<\/strong> <strong>Therapy<\/strong><\/td><td><strong>Starting dose<\/strong><\/td><td><strong>Max Dose<\/strong><\/td><td><strong>Contraindication<\/strong><\/td><td><strong>Breastfeeding<\/strong><\/td><\/tr><tr><td><strong>Labetalol<\/strong><\/td><td>1st line<\/td><td>100mg BD<\/td><td>600mg QDS<\/td><td>Asthma<\/td><td>Yes &#8211; only small amounts in breast milk<\/td><\/tr><tr><td><strong>Nifedipine<\/strong> <strong>(Coracten SR)<\/strong><\/td><td>2nd line<\/td><td>10mg MR BD<\/td><td>40mg MR BD<\/td><td>&nbsp;<\/td><td>Yes &#8211; amount too small to be harmful, manufacturer suggests avoid but widely used without reports neonatal effect<\/td><\/tr><tr><td><strong>Methyldopa<\/strong><\/td><td>2nd line<\/td><td>250mg BD<\/td><td>1g TDS<\/td><td>Depression<\/td><td>Yes<\/td><\/tr><tr><td><strong>Hydralazine<\/strong><\/td><td>2nd line<\/td><td>25mg TDS<\/td><td>75mg QDS<\/td><td>&nbsp;<\/td><td>Yes<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Postnatal hypertension medication recommendation if breastfeeding &#8211; if not breastfeeding as per Adult Hypertension guidelines<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Drug<\/strong><\/td><td><strong>Place in Therapy<\/strong><\/td><td><strong>Starting dose<\/strong><\/td><td><strong>Max Dose<\/strong><\/td><td><strong>Contraindication<\/strong><\/td><td><strong>Breastfeeding<\/strong><\/td><\/tr><tr><td><strong>Enalapril<\/strong><\/td><td>1st line &#8211; requires K and renal function monitoring<\/td><td>5mg OD<\/td><td>40mg OD<\/td><td>&nbsp;<\/td><td>Yes &#8211; low concentrations excreted, probably too small to be harmful<\/td><\/tr><tr><td><strong>Nifedipine<\/strong>                              <br><strong>(Coracten SR)<\/strong><\/td><td>2nd line<\/td><td>10mg MR BD<\/td><td>40mg MR BD<\/td><td>&nbsp;<\/td><td>Yes &#8211; amount too small to be harmful, manufacturer suggests avoid but widely used without reports neonatal effect<\/td><\/tr><tr><td><strong>Labetalol<\/strong><\/td><td>3rd line<\/td><td>100mg BD<\/td><td>600mg QDS<\/td><td>Asthma<\/td><td>Yes &#8211; only small amounts in breast milk<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">NICE guideline 133: Hypertension in Pregnancy- Diagnosis and Management \u2013 25<sup>th<\/sup> June 2019<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.nice.org.uk\/guidance\/NG133\" target=\"_blank\" rel=\"noopener\">Overview | Hypertension in pregnancy: diagnosis and management | Guidance | NICE<\/a><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Hypertension in the postnatal period Information Hypertensive disorders during pregnancy affect around 8-10% of all pregnant women and can be associated with substantial complications for the woman and the baby including maternal morbidity, stillbirths, neonatal deaths and perinatal morbidity. Women with hypertension in pregnancy are also at increased risk of CVS disease in later life.<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4337,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[898],"class_list":["post-14298","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-postnatal-hypertension-2"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/pregnancy\/https-apps-nhslothian-scot-refhelp-postnatal-hypertension-2\/\" rel=\"tag\">Postnatal Hypertension<\/a>","rttpg_excerpt":"Hypertension in the postnatal period Information Hypertensive disorders during pregnancy affect around 8-10% of all pregnant women and can be associated with substantial complications for the woman and the baby including maternal morbidity, stillbirths, neonatal deaths and perinatal morbidity. Women with hypertension in pregnancy are also at increased risk of CVS disease in later life.","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14298","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=14298"}],"version-history":[{"count":0,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14298\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4337"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=14298"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=14298"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}