P 4 Diagnosis, management and care of hypertensive disorders of pregnancy (HDP) in India – An Indian expert opinion

Introduction Hypertension is the second most common direct cause of maternal mortality worldwide with greater prevalence in developing world. Studies on HDP in India are limited and there is no uniformity for screening, diagnosis, care and management of HDP in India. Objective To review the available evidence and prepare a treatment consensus for screening, diagnosis, care and management of HDP in India. Method Major databases were searched for literature on HDP. A committee of 14 Obstetrics and Gynecology experts were formed in scientific collaboration with Wockhardt Ltd., Mumbai, India. The discussions and consensus from the expert discussions were drafted and refined as Expert Opinion on screening, diagnosis, care and management of HDP in India. Results The Expert Panel recommended NICE guidelines to classify hypertension. The panel also advised to follow guidelines on antenatal care and perform thorough clinical examination of the patient on first visit preferably in first trimester and then subsequent visits during the pregnancy. Dietary counselling should be provided to pregnant women. Panel emphasized use of standard mercury sphygmomanometer for accurate measurement of B.P in the sitting position. Minimum of four antenatal care visits and initial screening (BP and proteinuria) at 8 to 12 weeks of gestation for early diagnosis of hypertension was advised. Choosing a safe antihypertensive is important. Panel recommended either labetalol or methyldopa as the first line treatment during third trimester of pregnancy. However, during second trimester methyldopa should be used as first line treatment. Conclusion This Expert opinion document is a comprehensive guide on HDP for Health Care Professionals in India. Types of HDP, major complications associated with it and their management during pregnancy, at the time of delivery and postpartum care has been elucidated. Awareness among pregnant women, family members and proper training of health care professionals forms the basis for effective management of HDP in India. Download high-res image (800KB) Download full-size image Download high-res image (460KB) Download full-size image