Abstract
Objective
This guideline was developed by maternity care providers from obstetrics and internal
medicine. It reviews the diagnosis, evaluation, and management of the hypertensive
disorders of pregnancy (HDPs), the prediction and prevention of preeclampsia, and
the postpartum care of women with a previous HDP.
Target population
Pregnant women.
Benefits, harms, and costs
Implementation of the recommendations in these guidelines may reduce the incidence
of the HDPs, particularly preeclampsia, and associated adverse outcomes.
Evidence
A comprehensive literature review was updated to December 2020, following the same
methods as for previous Society of Obstetricians and Gynaecologists of Canada (SOGC)
HDP guidelines, and references were restricted to English or French. To support recommendations
for therapies, we prioritized randomized controlled trials and systematic reviews
(if available), and evaluated substantive clinical outcomes for mothers and babies.
Validation methods
The authors agreed on the content and recommendations through consensus and responded
to peer review by the SOGC Maternal Fetal Medicine Committee. The authors rated the
quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, along with the option of designating a recommendation as a “good
practice point.” See online Appendix A (Tables A1 for definitions and A2 for interpretations
of strong and conditional [weak] recommendations).The Board of the SOGC approved the
final draft for publication.
Intended users
All health care providers (obstetricians, family doctors, midwives, nurses, and anesthesiologists)
who provide care to women before, during, or after pregnancy.
RECOMMENDATIONS
- 1.Pre-conception counselling is suggested for women with pre-pregnancy hypertension to advise on individualized management during pregnancy (conditional, low).
- 2.Replacing angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) with other antihypertensives in women planning pregnancy is recommended unless there is a compelling clinical indication not to (strong, low).
- 3.In early pregnancy, women should be screened, at a minimum, for clinical risk markers for preeclampsia (strong, moderate).
- 4.If testing is available, women should be screened at 11–14 weeks gestation using a combination of clinical risk markers, uterine artery pulsatility index, and placental growth factor (PlGF) to individualize the risk of developing preeclampsia (strong, moderate).
- 5.For women at increased risk of preeclampsia, low-dose acetylsalicylic acid (81 or 162 mg/d) is recommended (strong, high), to be taken at bedtime (strong, moderate), preferably before 16 weeks gestation (conditional, moderate), and discontinued by 36 weeks gestation (conditional, low).
- 6.For all other women, low-dose acetylsalicylic acid is not recommended (strong, moderate).
- 7.For all women with low dietary intake of calcium (<900 mg/d), oral calcium supplementation of at least 500 mg/d is suggested to prevent preeclampsia (conditional, low).
- 8.For all women, vitamin D supplementation over and above Health Canada’s recommendation for adults is not suggested to prevent preeclampsia (conditional, moderate).
- 9.For all women, exercise is recommended to prevent preeclampsia (strong, moderate).
- 10.For women at increased risk of preeclampsia, who are overweight or obese dietary advice (reduce calories and choose foods with a low glycemic index) and exercise are recommended (conditional, moderate).
- 11.Inpatient care should be provided for women with severe hypertension or preeclampsia with 1 or more maternal adverse conditions (good practice point).
- 12.Bed rest is not suggested for any women with preeclampsia (conditional, low).
- 13.Antihypertensive therapy is recommended for pregnant women with an average systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, regardless of the hypertensive disorder of pregnancy (strong, moderate).
- 14.A diastolic blood pressure of 85 mm Hg should be targeted for pregnant women on antihypertensive therapy with chronic or gestational hypertension (strong, moderate), and a similar target, considered for women with preeclampsia (conditional, low).
- 15.Antihypertensive therapy (oral or parenteral) is urgently recommended for women with severe hypertension (i.e., systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg) in pregnancy or postpartum (strong, low).
- 16.Magnesium sulphate is recommended for first-line treatment of eclampsia and prophylaxis against eclampsia in women with preeclampsia and severe hypertension or adverse maternal conditions (strong, high).
- 17.Platelet transfusion should be considered if a woman’s platelet count is <20 × 109/L before vaginal delivery or <50 × 109/L before cesarean delivery, or at any time if there is excessive active bleeding, known platelet dysfunction, rapidly falling platelet count, or coagulopathy (strong, low).
- 18.For women with chronic hypertension, expectant care should be undertaken from fetal viability to <370 weeks gestation, unless there is an indication for birth (strong, very low). Initiation of delivery can be offered at 380 to 396 weeks gestation but should be advised from 400 weeks gestation (conditional, low).
- 19.For women with gestational hypertension, expectant care should be undertaken from fetal viability to <370 weeks, unless there is an indication for birth (strong, low). When gestational hypertension arises before 370 weeks, initiation of delivery can be offered at 380 to 396 weeks gestation but should be advised from 400 weeks gestation (conditional, low). For women who are already at 370 weeks gestation or later and present with gestational hypertension, initiation of delivery should be discussed (strong, moderate).
- 20.For women with preeclampsia, expectant management may be considered from fetal viability until <340 weeks gestation, but only in perinatal centres capable of caring for very preterm infants (conditional, moderate). At 340–356 weeks gestation, initiation of delivery should be discussed, as it decreases maternal but increases neonatal risk, particularly if antenatal corticosteroids are not prescribed (strong, moderate). At 360–366 weeks gestation, initiation of delivery should be considered (strong, moderate). At 370 weeks gestation or later, initiation of delivery is recommended (strong, high).
- 21.Blood pressure should be measured regularly (at least twice) in the first 2 weeks after delivery in women with hypertension (good practice point).
- 22.As women may develop preeclampsia for the first time postpartum, those with new or worsening hypertension and/or symptoms of preeclampsia should be evaluated accordingly (good practice point).
- 23.For lactating women, the following antihypertensive drugs are suggested: labetalol, methyldopa, nifedipine, enalapril, and captopril (conditional, low).
- 24.Clinical follow-up should be provided for women with gestational hypertension and preeclampsia to ensure normalization of hypertension, clinical features, and laboratory test results (good practice point).
- 25.Women with gestational hypertension and preeclampsia may benefit from interventions to reduce their risk of a hypertensive disorder of pregnancy in a future pregnancy and from screening for cardiovascular risk factors (conditional, low).
Keywords
Abbreviations:
ACE (angiotensin-converting enzyme), ACR (albumin:creatinine ratio), ARB (angiotensin-receptor blocker), ASA (acetylsalicylic acid), AST (aspartate aminotransferase), ALT (alanine aminotransferase), CKD (chronic kidney disease), FHR (fetal heart rate), FMF (Fetal Medicine Foundation), HDP (hypertensive disorder of pregnancy), PCR (protein:creatinine ratio), PIERS (Pre-eclampsia Integrated Estimate of Risk Score), PlGF (placental growth factor)To read this article in full you will need to make a payment
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References
- Protocol for measurement of mean arterial pressure at 11-13 weeks' gestation.Fetal Diagn Ther. 2012; 31: 42-48
- Out of Office Blood Pressure Measurement in Pregnancy and the Postpartum Period.Current hypertension reports. 2018; 20: 101
- Blood pressure monitoring in high-risk pregnancy to improve the detection and monitoring of hypertension (the BUMP 1 and 2 trials): protocol for two linked randomised controlled trials.BMJ Open. 2020; 10e034593
- Home blood pressure monitoring in the antenatal and postpartum period: A systematic review meta-analysis.Pregnancy Hypertens. 2020; 19: 44-51
- Hypertension Canada's 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children.Can J Cardiol. 2020; 36: 596-624
- Challenging the definition of hypertension in pregnancy: a retrospective cohort study.Am J Obstet Gynecol. 2020; 222: 606 e1-606 e21
- STRIDEBP. STRIDE-BP: Validated BP monitors in pregnancy.(Available at)https://stridebp.org/bp-monitorsDate accessed: January 2, 2021
- Self-monitored blood pressure device accuracy test (American Heart Association and American Medical Association).(Available at)https://targetbp.org/tools_downloads/device-accuracy-test/Date accessed: November 29, 2020
- How Do Home and Clinic Blood Pressure Readings Compare in Pregnancy?.Hypertension. 2018; 72: 686-694
- Transient gestational hypertension: Not always a benign event.Pregnancy Hypertens. 2012; 2: 22-27
- Diagnosis of White Coat Hypertension and pregnancy outcomes.Pregnancy Hypertens. 2018; 14: 121-124
- The natural history of white coat hypertension during pregnancy.BJOG. 2005; 112: 601-606
- Temporary hypertension and white coat hypertension in the first trimester as risk factors for preeclampsia.Hypertens Res. 2019; 42: 2002-2012
- Blood pressure assessments in different subtypes of hypertensive pregnant women: office versus home patient- or nurse-measured blood pressure.Hypertens Pregnancy. 2009; 28: 168-177
- Office blood pressure values and the necessity of out-of-office measurements in high-risk pregnancies.J Hypertens. 2019; 37: 1838-1844
- Preeclampsia Screening: Evidence Report and Systematic Review for the US Preventive Services Task Force.JAMA. 2017; 317: 1668-1683
- Outcome of pregnancy with new onset proteinuria and progression to pre-eclampsia: A retrospective analysis.Pregnancy Hypertens. 2018; 12: 174-177
- Choosing Wisely: SOGC's Top 10 Recommendations.J Obstet Gynaecol Can. 2018; 40: 716-722
- Chronic hypertension in pregnancy and the risk of congenital malformations: a cohort study.American journal of obstetrics and gynecology. 2015; 212: 337.e1-337.e14
- Maternal hypertensive disorders, antihypertensive medication use, and the risk of birth defects: a case-control study.BJOG. 2015; 122: 1002-1009
- Maternal and perinatal outcomes associated with the use of renin-angiotensin system (RAS) blockers for chronic hypertension in early pregnancy.Pregnancy Hypertens. 2018; 14: 156-161
- Teratogenicity of angiotensin converting enzyme inhibitors or receptor blockers.J Obstet Gynaecol. 2011; 31: 465-472
- Angiotensin-Converting Enzyme Inhibitors and the Risk of Congenital Malformations.Obstet Gynecol. 2017; 129: 174-184
- ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy.Obstet Gynecol. 2019; 133: e26-e50
- 2020 International Society of Hypertension Global Hypertension Practice Guidelines.Hypertension. 2020; 75: 1334-1357
- Biomarkers and the prediction of adverse outcomes in preeclampsia: a systematic review and meta-analysis.Obstet Gynecol. 2021; 137: 72-81
- Prediction of adverse maternal outcomes from pre-eclampsia and other hypertensive disorders of pregnancy: A systematic review.Pregnancy Hypertens. 2018; 11: 115-123
- A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings: the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) multi-country prospective cohort study.PLoS Med. 2014; 11e1001589
- Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model.Lancet. 2011; 377: 219-227
- Hypertension in pregnancy: [C] Evidence review for prediction of complications in pre-eclampsia.(Available at)https://www.nice.org.uk/guidance/ng133/evidence/c-prediction-of-complications-in-preeclampsia-pdf-6836186128Date: 2019Date accessed: February 15, 2022
- Temporal and external validation of the fullPIERS model for the prediction of adverse maternal outcomes in women with pre-eclampsia.Pregnancy Hypertens. 2019; 15: 42-50
- fullPIERS risk calculator for adverse maternal outcome in pre-eclampsia.(Available at)https://pre-empt.obgyn.ubc.ca/evidence/fullpiersDate accessed: October 19, 2022
- Development and validation of Prediction models for Risks of complications in Early-onset Pre-eclampsia (PREP): a prospective cohort study.Health technology assessment (Winchester, England). 2017; 21: 1-100
- Assessing the incremental value of blood oxygen saturation (SpO(2)) in the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) Risk Prediction Model.J Obstet Gynaecol Can. 2015; 37: 16-24
- Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial.Lancet. 2002; 359: 1877-1890
- Uric Acid as a predictor of adverse maternal and perinatal outcomes in women hospitalized with preeclampsia.J Obstet Gynaecol Can. 2014; 36: 870-877
- Plasma uric acid remains a marker of poor outcome in hypertensive pregnancy: a retrospective cohort study.BJOG. 2012; 119: 484-492
- Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial.Lancet. 2019; 393: 1807-1818
- Placental growth factor in assessment of women with suspected pre-eclampsia to reduce maternal morbidity: a stepped wedge cluster randomised control trial (PARROT Ireland).BMJ. 2021; 374: n1857
- Angiogenic factors in diagnosis, management, and research in preeclampsia.Hypertension. 2014; 63: 198-202
- Fetal and umbilical Doppler ultrasound in high-risk pregnancies.Cochrane Database Syst Rev. 2017; 6: CD007529
- Risk of fetal death in growth-restricted fetuses with umbilical and/or ductus venosus absent or reversed end-diastolic velocities before 34 weeks of gestation: a systematic review and meta-analysis.Am J Obstet Gynecol. 2018; 218: S774-S82 e21
- ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction.Ultrasound Obstet Gynecol. 2020; 56: 298-312
- An assessment of predictive value of the biophysical profile in women with preeclampsia using data from the fullPIERS database.Pregnancy Hypertens. 2013; 3: 166-171
- Development and internal validation of a multivariable model to predict perinatal death in pregnancy hypertension.Pregnancy Hypertens. 2015; 5: 315-321
- Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation: comparison with NICE guidelines and ACOG recommendations.Ultrasound Obstet Gynecol. 2017; 49: 756-760
- Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies.BMJ. 2016; 353: i1753
- A Systematic Review and Meta-Analysis of Outcomes of Pregnancy in CKD and CKD Outcomes in Pregnancy.Clin J Am Soc Nephrol. 2015; 10: 1964-1978
- Guideline No. 391-Pregnancy and Maternal Obesity Part 1: Pre-conception and Prenatal Care.J Obstet Gynaecol Can. 2019; 41: 1623-1640
- Risk assessment: Risk for preeclampsia.(Available at)https://fetalmedicine.org/research/assess/preeclampsia/first-trimesterDate: December 29, 2020
- Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation.Am J Obstet Gynecol. 2016; 214: 103 e1-103 e12
- Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia.N Engl J Med. 2017; 377: 613-622
- Low-dose ASA response using the PFA-100 in women with high-risk pregnancy.J Obstet Gynaecol Can. 2009; 31: 1022-1027
- Low dose aspirin and pregnancy: how important is aspirin resistance?.BJOG. 2016; 123: 1481-1487
- Antiplatelet agents for preventing pre-eclampsia and its complications.Cochrane Database Syst Rev. 2019; 2019: CD004659
- Preeclampsia Prevention Using Routine Versus Screening Test-Indicated Aspirin in Low-Risk Women.Hypertension. 2018; 72: 1391-1396
- Complications and Safety of Preconception Low-Dose Aspirin Among Women With Prior Pregnancy Losses.Obstet Gynecol. 2016; 127: 689-698
- Low-Dose Aspirin for Preventing Preeclampsia and Its Complications: A Meta-Analysis.J Clin Hypertens (Greenwich). 2015; 17: 567-573
- Effect of regular oral intake of aspirin during pregnancy on pregnancy outcome of high-risk pregnancy-induced hypertension syndrome patients.Eur Rev Med Pharmacol Sci. 2016; 20: 5013-5016
- Aspirin use during pregnancy and the risk of bleeding complications: a Swedish population-based cohort study.Am J Obstet Gynecol. 2020; 224: 95.e1-95.e12
- Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis.Am J Obstet Gynecol. 2018; 218: 287-293 e1
- Strategies for Prescribing Aspirin to Prevent Preeclampsia: A Cost-Effectiveness Analysis.Obstet Gynecol. 2019; 134: 537-544
- A Cost-Benefit Analysis of Low-Dose Aspirin Prophylaxis for the Prevention of Preeclampsia in the United States.Obstet Gynecol. 2015; 126: 1242-1250
- Vitamin D and calcium: Updated dietary reference intakes. 2021. S0002-9378(20):[31288-6 pp.].(Available at)
- Calcium supplementation commencing before or early in pregnancy, for preventing hypertensive disorders of pregnancy.Cochrane Database Syst Rev. 2019; 9: CD011192
- Prepregnancy and early pregnancy calcium supplementation among women at high risk of pre-eclampsia: a multicentre, double-blind, randomised, placebo-controlled trial.Lancet. 2019; 393: 330-339
- Vitamin D supplementation for women during pregnancy.Cochrane Database Syst Rev. 2019; 7: CD008873
- Regimens of vitamin D supplementation for women during pregnancy.Cochrane Database Syst Rev. 2019; 10: CD013446
- No. 367-2019 Canadian Guideline for Physical Activity throughout Pregnancy.J Obstet Gynaecol Can. 2018; 40: 1528-1537
- Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis.Br J Sports Med. 2018; 52: 1367-1375
- An early, customized low-glycemic-index diet prevents adverse pregnancy outcomes in overweight/obese women.Minerva Ginecol. 2018; 70: 254-260
- Adherence to a lifestyle programme in overweight/obese pregnant women and effect on gestational diabetes mellitus: a randomized controlled trial.Matern Child Nutr. 2017; 13
- Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial.Lancet Diabetes Endocrinol. 2015; 3: 767-777
- Effect of high dose folic acid supplementation in pregnancy on pre-eclampsia (FACT): double blind, phase III, randomised controlled, international, multicentre trial.BMJ. 2018; 362: k3478
- Low-molecular-weight heparin for prevention of preeclampsia and other placenta-mediated complications: a systematic review and meta-analysis.Am J Obstet Gynecol. 2021; (S0002-9378:31288-6)
- Fetal health surveillance: antepartum and intrapartum consensus guideline.J Obstet Gynaecol Can. 2007; 29: S3-S56
- Hypertensive disorders of pregnancy toolkit.(Available at)https://www.cmqcc.org/resources-tool-kits/toolkits/preeclampsia-toolkitDate accessed: February 15, 2022
- Maternal transport policy.J Obstet Gynaecol Can. 2005; 27: 956-963
- Bed rest with or without hospitalisation for hypertension during pregnancy.Cochrane Database Syst Rev. 2005; : CD003514
- Guided imagery for treating hypertension in pregnancy.The Cochrane database of systematic reviews. 2019; 4: CD011337
- Less-tight versus tight control of hypertension in pregnancy.The New England journal of medicine. 2015; 372: 407-417
- Hypertension Canada's 2018 Guidelines for the Management of Hypertension in Pregnancy.The Canadian journal of cardiology. 2018; 34: 526-531
- Management of non-severe pregnancy hypertension - A summary of the CHIPS Trial (Control of Hypertension in Pregnancy Study) research publications.Pregnancy Hypertens. 2019; 18: 156-162
- Hypertension in pregnancy: diagnosis and management.(Available at)
- Use of Antihypertensive Medications During Delivery Hospitalizations Complicated by Preeclampsia.Obstetrics and gynecology. 2018; 131: 441-450
- Antihypertensive drug therapy for mild to moderate hypertension during pregnancy.The Cochrane database of systematic reviews. 2018; 10: CD002252
- Comparative efficacy and safety of oral antihypertensive agents in pregnant women with chronic hypertension: a network metaanalysis.Am J Obstet Gynecol. 2020; 223: 525-537
- Should Maternal Hemodynamics Guide Antihypertensive Therapy in Preeclampsia?.Hypertension. 2018; 71: 550-556
- Use of Antihypertensive Medications and Uterotonics During Delivery Hospitalizations in Women With Asthma.Obstetrics and gynecology. 2018; 132: 185-192
- The screening and management of newborns at risk for low blood glucose.Paediatr Child Health. 2019; 24: 536-554
- Maternal hypertension, medication use, and hypospadias in the National Birth Defects Prevention Study.Obstetrics and gynecology. 2014; 123: 309-317
- In-utero exposure to antihypertensive medication and neonatal and child health outcomes: a systematic review.Journal of hypertension. 2017; 35: 2123-2137
- Timely treatment of severe maternal hypertension and reduction in severe maternal morbidity.Pregnancy hypertension. 2018; 14: 55-58
- Drugs for treating severe hypertension in pregnancy: a network meta-analysis and trial sequential analysis of randomized clinical trials.Br J Clin Pharmacol. 2018; 84: 1906-1916
- Drugs for treatment of very high blood pressure during pregnancy.The Cochrane Database of Systematic Reviews. 2013; : CD001449
- The flipside of hydralazine in pregnancy: A systematic review and meta-analysis.Pregnancy Hypertens. 2020; 19: 177-186
- Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial.Lancet. 2019; 394: 1011-1021
- Therapy with both magnesium sulfate and nifedipine does not increase the risk of serious magnesium-related maternal side effects in women with preeclampsia.Am J Obstet Gynecol. 2005; 193: 153-163
- Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222.Obstet Gynecol. 2020; 135: e237-e260
- Magnesium sulphate versus diazepam for eclampsia.Cochrane Database Syst Rev. 2010; : CD000127
- Alternative regimens of magnesium sulfate for treatment of preeclampsia and eclampsia: a systematic review of non-randomized studies.Acta obstetricia et gynecologica Scandinavica. 2016; 95: 144-156
- Clinical pharmacokinetic properties of magnesium sulphate in women with pre-eclampsia and eclampsia.BJOG. 2016; 123: 356-366
- No. 376-Magnesium Sulphate for Fetal Neuroprotection.J Obstet Gynaecol Can. 2019; 41: 505-522
- Acute pulmonary oedema as a complication of hypertension during pregnancy.Hypertens Pregnancy. 2011; 30: 169-179
- The influence of fluid management on outcomes in preeclampsia: a systematic review and meta-analysis.International journal of obstetric anesthesia. 2018; 34: 85-95
- Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy.Cochrane Database Syst Rev. 2010; : CD008148
- Effects of high-dose dexamethasone in postpartum women with class 1 haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome.J Obstet Gynaecol. 2019; 39: 335-339
- No. 364-Antenatal Corticosteroid Therapy for Improving Neonatal Outcomes.J Obstet Gynaecol Can. 2018; 40: 1219-1239
- Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications.Am J Obstet Gynecol. 2007; 196: 514 e1-514 e9
- Temporising versus interventionist management (preterm and at term).Best Pract Res Clin Obstet Gynaecol. 2011; 25: 463-476
- No. 347-Obstetric Management at Borderline Viability.J Obstet Gynaecol Can. 2017; 39: 781-791
- Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation.Cochrane Database Syst Rev. 2018; 10: CD003106
- Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial.Lancet. 2019; 394: 1181-1190
- Delivery versus expectant monitoring for late preterm hypertensive disorders of pregnancy (HYPITAT-II): a multicenter, open label, randomized controlled trial.American journal of obstetrics and gynecology. 2014; 210: S2-S3
- Neonatal developmental and behavioral outcomes of immediate delivery versus expectant monitoring in mild hypertensive disorders of pregnancy: 5-year outcomes of the HYPITAT II trial.Eur J Obstet Gynecol Reprod Biol. 2020; 244: 172-179
- Delivery or expectant management for prevention of adverse maternal and neonatal outcomes in hypertensive disorders of pregnancy: an individual participant data meta-analysis.Ultrasound Obstet Gynecol. 2019; 53: 443-453
- Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomised controlled trial.Lancet. 2009; 374: 979-988
- What is the optimal time for delivery in women with gestational hypertension?.Am J Obstet Gynecol. 2012; 207: 214 e1-6
- Timing of Delivery in Women With Chronic Hypertension.Obstet Gynecol. 2018; 132: 669-677
- Optimal timing of delivery in pregnancies with pre-existing hypertension.BJOG. 2011; 118: 49-54
- Induction of labour.J Obstet Gynaecol Can. 2013; 35: 840-857
- No. 235-Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage.J Obstet Gynaecol Can. 2018; 40: e841-e855
- Postpartum hypertensive disorders in the Emergency Department - A retrospective review of local practice in Calgary, Alberta.Pregnancy Hypertens. 2020; 19: 212-217
- Postpartum management of hypertensive disorders of pregnancy: a systematic review.BMJ Open. 2017; 7e018696
- Postpartum hypertensive disorders in the Emergency Department - A retrospective review of local practice in Calgary, Alberta.Pregnancy Hypertens. 2020; 19: 212-217
- Self-Management of Postnatal Hypertension: The SNAP-HT Trial.Hypertension. 2018; 72: 425-432
- Resolution of hypertension and proteinuria after preeclampsia.Obstet Gynecol. 2009; 114 (https://doi.org/10.097/AOG.0b013e3181c14e3e): 1307-1314
- Pregnancy-related cardiovascular risk indicators: Primary care approach to postpartum management and prevention of future disease.Can Fam Physician. 2019; 65: 883-889
- Interpregnancy Weight Change and Hypertension During Pregnancy: A Systematic Review and Meta-analysis.Obstet Gynecol. 2020; 135: 68-79
- Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy.Heart. 2019; 105: 1273-1278
- Incidence and Long-Term Outcomes of Hypertensive Disorders of Pregnancy.J Am Coll Cardiol. 2020; 75: 2323-2334
- 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult.Can J Cardiol. 2021; 37: 1129-1150
- Spot protein-creatinine ratio and spot albumin-creatinine ratio in the assessment of pre-eclampsia: a diagnostic accuracy study with decision-analytic model-based economic evaluation and acceptability analysis.Health technology assessment (Winchester, England). 2017; 21: 1-90
- The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice.Pregnancy Hypertens. 2021; 27: 148-169
- Pregnancy-related mortality in the United States, 1998 to 2005.Obstet Gynecol. 2010; 116: 1302-1309
- Pregnancy hypertension diagnosis and care in COVID-19 era and beyond.Ultrasound Obstet Gynecol. 2020; 56: 7-10
Article info
Publication history
No. 426, May 2022 (Replaces No. 307, May 2014)
Footnotes
This document reflects emerging clinical and scientific advances as of the publication date and is subject to change. The information is not meant to dictate an exclusive course of treatment or procedure. Institutions are free to amend the recommendations. The SOGC suggests, however, that they adequately document any such amendments.
Informed consent: Patients have the right and responsibility to make informed decisions about their care in partnership with their health care provider. In order to facilitate informed choice, patients should be provided with information and support that is evidence-based, culturally appropriate, and personalized. The values, beliefs and individual needs of each patient in the context of their personal circumstances should be considered and the final decision about care and treatment options chosen by the patient should be respected.
Language and inclusivity: The SOGC recognizes the importance to be fully inclusive and when context is appropriate, gender-neutral language will be used. In other circumstances, we continue to use gendered language because of our mission to advance women’s health. The SOGC recognizes and respects the rights of all people for whom the information in this document may apply, including but not limited to transgender, non-binary, and intersex people. The SOGC encourages health care providers to engage in respectful conversation with their patients about their gender identity and preferred gender pronouns and to apply these guidelines in a way that is sensitive to each person’s needs.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
