{"id":98,"date":"2021-11-11T15:18:32","date_gmt":"2021-11-11T15:18:32","guid":{"rendered":"https:\/\/obgconnect.com\/senseclinical\/?p=98"},"modified":"2021-11-12T19:10:29","modified_gmt":"2021-11-12T19:10:29","slug":"acog-preeclampsia-guidelines-antenatal-management-and-timing-of-delivery","status":"publish","type":"post","link":"https:\/\/obgconnect.com\/senseclinical\/2021\/11\/11\/acog-preeclampsia-guidelines-antenatal-management-and-timing-of-delivery\/","title":{"rendered":"ACOG Preeclampsia Guidelines: Antenatal Management and Timing of Delivery"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">SUMMARY:<\/h2>\n\n\n\n<p>Recommendations for prenatal assessment and perinatal management, including delivery, are included in the ACOG preeclampsia and gestational hypertension guidelines.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Inpatient vs Outpatient Management<\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li>Ambulatory management (outpatient) appropriate for the following<ul><li>Gestational hypertension <em>without <\/em>severe features <strong>or<\/strong><\/li><li>Preeclampsia <em>without<\/em> severe features<\/li><\/ul><\/li><li>Inpatient management appropriate for the following<ul><li>Severe preeclampsia <strong>or<\/strong><\/li><li>Poor adherence to monitoring recommendations<\/li><\/ul><\/li><\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to Measure BP<\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li>Recommended technique for BP monitoring<ul><li>Appropriate cuff size: 1.5 times upper arm circumference<\/li><li>Avoid tobacco or caffeine: Use in the 30 minutes preceding the measurement may lead to temporary rise in blood pressure<\/li><li>Patient should be upright after a 10-minute rest period<\/li><li>Inpatient setting: Measurement may be taken either<ul><li>Sitting up <strong>or<\/strong><\/li><li>Left lateral recumbent with arm at the level of the heart<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Fetal and Maternal Assessment (Outpatient \u2013 No Severe Features)<\/h3>\n\n\n\n<p><em>Fetal Assessment<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Fetal growth assessment every 3-4 weeks<\/li><li>Amniotic fluid assessment weekly<\/li><li>Antenatal testing 1-2 times per week<\/li><\/ul>\n\n\n\n<p><em>Maternal Assessment<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Labs weekly (more frequently if concern that patient status is deteriorating)<ul><li>Serum creatinine | Liver enzymes | Platelet count<\/li><li>Gestational hypertension: Include proteinuria<\/li><li><strong>Note<\/strong>: If proteinuria is present, additional proteinuria measurements are <em>not <\/em>necessary<\/li><\/ul><\/li><li>Clinical evaluation: At least one visit per week in-clinic<ul><li>Obtain BP and evaluate for severe features (see \u2018Related ObG Topics\u2019 below)<ul><li>Combination ambulatory and in-clinic assessment<\/li><\/ul><\/li><li>BP and symptom assessment are recommended &#8220;serially&#8221;, using a combination of in-clinic and ambulatory approaches, with at least one visit per week in-clinic<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Note: <\/strong>No RCT data are available to determine optimal maternal or fetal monitoring protocols<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">KEY POINTS:<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Delivery vs Expectant Management<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Decision regarding management based on gestational age and results from the following evaluation<ul><li>Maternal: CBC | Creatinine | LDH, AST, ALT | Proteinuria | Uric acid if superimposed preeclampsia suspected<\/li><li>Fetal: EFW | Amniotic fluid volume | Antenatal testing (BPP, NST)<\/li><\/ul><\/li><li>Candidate for expectant management<ul><li>Gestational hypertension or preeclampsia <em>without<\/em> severe features &lt;37w0d<\/li><li>Reassuring antenatal testing<\/li><li>Intact membranes<\/li><li>No vaginal bleeding<\/li><li>No evidence of active preterm labor<\/li><li><strong>Note: <\/strong>Delivery at 37w0d | HYPITAT trial showed no benefit to expectant management beyond 37 weeks<\/li><\/ul><\/li><li>Candidate for delivery (expectant management not advised)<ul><li>Severe range hypertension unresponsive to antihypertensive agent(s)<\/li><li>Persistent headache or persistent RUQ\/epigastric pain unresponsive to treatment<\/li><li>Visual disturbance or altered sensorium or motor deficit<\/li><li>Stroke or MI<\/li><li>HELLP syndrome<\/li><li>Worsening renal function (Cr above 1.1 or double the baseline)<\/li><li>Pulmonary edema<\/li><li>Eclampsia<\/li><li>Placental abruption or bleeding in the absence of placenta previa<\/li><li>Abnormal antenatal testing<\/li><li>Fetal demise<\/li><li>Fetal lethal anomaly or extreme prematurity<\/li><li>UA Doppler REDF<\/li><li><strong>Note: <\/strong>Fetal growth restriction, if other fetal assessment parameters are within normal range, is not an indication for delivery<\/li><\/ul><\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Expectant Management for Severe Preeclampsia<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Shared decision making: Consider risk\/benefit<ul><li>Expectant management for severe preeclampsia provides benefit to fetus\/newborn but potential risk to mother<\/li><\/ul><\/li><li>Risks of expectant management in the presence of severe features<ul><li>Pulmonary edema | MI | Stroke | ARDS | Coagulopathy | Renal failure | Retinal injury<\/li><\/ul><\/li><li>\u226534w0d: Delivery is recommended<ul><li>Do not delay delivery to administer steroids in late preterm<\/li><\/ul><\/li><li>&lt;34w0d: Expectant management for women who are clinically stable&nbsp;<ul><li>Associated with higher GA (on average 1-2 weeks) at delivery | Improved neonatal outcomes<\/li><li>&#8220;Low maternal risk&#8221; in studies<\/li><li>Requires close maternal and fetal monitoring with serial laboratory testing<ul><li>Deliver if maternal or fetal status deteriorates<\/li><\/ul><\/li><li>Corticosteroid administration is recommended<ul><li>\u201cMay not always be advisable\u201d to delay delivery when indicated to provide full steroid course<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Learn More &#8211; Primary Sources:<\/h2>\n\n\n\n<p><a href=\"https:\/\/journals.lww.com\/greenjournal\/Abstract\/2020\/06000\/Gestational_Hypertension_and_Preeclampsia__ACOG.46.aspx?sessionEnd=true\" target=\"_blank\" rel=\"noreferrer noopener\">ACOG Practice Bulletin 222: Gestational Hypertension and Preeclampsia<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.bmj.com\/content\/366\/bmj.l2381\" target=\"_blank\" rel=\"noreferrer noopener\">Pre-eclampsia: pathophysiology and clinical implications<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full\/10.1002\/ijgo.13763\" target=\"_blank\" rel=\"noreferrer noopener\">FIGO: A literature review and best practice advice for second and third trimester risk stratification, monitoring, and management of pre-eclampsia<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Locate a Maternal Fetal Medicine Specialist<\/h2>\n\n\n\n<p><a href=\"https:\/\/www.smfm.org\/members\" target=\"_blank\" rel=\"noreferrer noopener\">Maternal Fetal Medicine Specialist Locator-SMFM<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>SUMMARY: Recommendations for prenatal assessment and perinatal management, including delivery, are included in the ACOG preeclampsia and gestational hypertension guidelines. Inpatient vs Outpatient Management Ambulatory management (outpatient) appropriate for the following Gestational hypertension without severe features or Preeclampsia without severe features Inpatient management appropriate for the following Severe preeclampsia or Poor adherence to monitoring recommendations [&hellip;]<\/p>\n","protected":false},"author":2423,"featured_media":142,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[23],"tags":[],"class_list":["post-98","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hypertension"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ACOG Preeclampsia Guidelines: Antenatal Management and Timing of Delivery - SENSE Clinical<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/obgconnect.com\/senseclinical\/2021\/11\/11\/acog-preeclampsia-guidelines-antenatal-management-and-timing-of-delivery\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ACOG Preeclampsia Guidelines: Antenatal Management and Timing of Delivery - SENSE Clinical\" \/>\n<meta property=\"og:description\" content=\"SUMMARY: Recommendations for prenatal assessment and perinatal management, including delivery, are included in the ACOG preeclampsia and gestational hypertension guidelines. 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