Acog Preeclampsia Guidelines 2020 Pdf Download [TOP]

Low-dose aspirin has been used during pregnancy most commonly to prevent or delay the onset of preeclampsia 1. The previous recommendation from the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM), and the U.S. Preventive Services Task Force (USPSTF) has been for low-dose aspirin (81 mg/d) prophylaxis after 12 weeks of gestation in pregnant individuals at high risk of preeclampsia and suggested low-dose aspirin prophylaxis in pregnant individuals with more than one moderate-risk factor 1,2. ACOG and SMFM also have provided more detailed information around timing, recommending that low-dose aspirin be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery 1.

Based on the updated USPSTF guidance and its supporting evidence, ACOG and SMFM are revising their recommendation regarding low-dose aspirin prophylaxis for the prevention of preeclampsia. Low-dose aspirin (81 mg/d) prophylaxis is recommended for:

Acog Preeclampsia Guidelines 2020 Pdf Download

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A Practice Advisory is issued when information on an emergent clinical issue (e.g. clinical study, scientific report, draft regulation) is released that requires an immediate or rapid response, particularly if it is anticipated that it will generate a multitude of inquiries. A Practice Advisory is a brief, focused statement issued within 24-48 hours of the release of this evolving information and constitutes ACOG clinical guidance. A Practice Advisory is issued only on-line for Fellows but also may be used by patients and the media. Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines.This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center.

Some women have high blood pressure before they get pregnant. Others develop it for the first time during pregnancy. A serious high blood pressure disorder called preeclampsia can also happen during pregnancy or soon after childbirth.

Preeclampsia is a serious disorder that can affect all the organs in your body. It usually develops after 20 weeks of pregnancy, often in the third trimester. When it develops before 34 weeks of pregnancy, it is called early-onset preeclampsia. It can also develop in the weeks after childbirth.

For women with preeclampsia, early delivery may be needed in some cases. Preterm babies have an increased risk of problems with breathing, eating, staying warm, hearing, and vision. Some preterm complications last a lifetime and require ongoing medical care.

A high blood pressure reading may be the first sign of preeclampsia. If your blood pressure reading is high, it may be checked again to confirm the results. You may have a urine test to check for protein. You may also have tests to check how your liver and kidneys are working and to measure the number of platelets in your blood.

At 37 weeks of pregnancy, you and your ob-gyn may talk about delivery. Labor may be induced (started with medications). If test results show that the fetus is not doing well, you may need to have the baby earlier. Women with preeclampsia can have vaginal deliveries, but if there are problems during labor, cesarean birth may be needed.

If you have preeclampsia with severe features, you may be treated in the hospital. If you are at least 34 weeks pregnant, you and your ob-gyn may talk about having your baby as soon as your condition is stable.

You may have tests to check how your heart and kidneys are working. Your medications should be reviewed to see if you need to switch to others that are safer during pregnancy. You should also talk about the signs and symptoms of preeclampsia.

HELLP Syndrome: A severe type of preeclampsia. HELLP stands for hemolysis, elevated liver enzymes, and low platelet count.

Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide. It has been estimated that preeclampsia complicates 2-8% of pregnancies globally (). In Latin America and the Caribbean, hypertensive disorders are responsible for almost 26% of maternal deaths, whereas in Africa and Asia they contribute to 9% of deaths. Although maternal mortality is much lower in high-income countries than in developing countries, 16% of maternal deaths can be attributed to hypertensive disorders (). In the United States, the rate of preeclampsia increased by 25% between 1987 and 2004 (). Moreover, in comparison with women giving birth in 1980, those giving birth in 2003 were at 6.7-fold increased risk of severe preeclampsia (). This complication is costly: one study reported that in 2012 in the United States, the estimated cost of preeclampsia within the first 12 months of delivery was $2.18 billion ($1.03 billion for women and $1.15 billion for infants), which was disproportionately borne by premature births (). This Practice Bulletin will provide guidelines for the diagnosis and management of gestational hypertension and preeclampsia.

Preeclampsia is a pregnancy specific hypertensive disease with multi-system involvement. It usually occurs after 20 weeks of gestation and can be superimposed on another hypertensive disorder. While preeclampsia was historically defined by the new onset of hypertension in combination with proteinuria, some women will present with hypertension and multisystemic signs in the absence of proteinuria. The presence of multisystemic signs is an indication of disease severity.

Women with gestational hypertension with severe range blood pressures (a systolic blood pressure of 160 mm Hg or higher, or diastolic blood pressure of 110 mm Hg or higher) should be diagnosed with preeclampsia with severe features.

Although they have not been substantiated by research, the diagnostic criteria for preeclampsia developed by the National Blood Pressure Education Program Working Group are traditionally used in clinical practice and frequently employed in research protocols. They are as follows:

Although the exact incidence of preeclampsia remains unknown, this pregnancy-specific syndrome has been reported to affect 5 to 8 percent of pregnancies. Primarily a disorder of first pregnancies, it also occurs in many other settings, including multifetal gestations, chronic hypertension, and pregestational diabetes.

Vascular changes in preeclampsia and eclampsia include hemoconcentration and intense vasospasm. Women with severe preeclampsia and liver involvement may develop HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet counts), which increases the risk of adverse maternal and fetal outcomes. Persistent oliguria from acute tubular necrosis can result in acute renal failure. Maternal mortality is usually associated with intracranial hemorrhage.

Is there an effective test for identifying women at risk for preeclampsia? To date, no test has been shown to be reliable and cost-effective. The positive predictive value of uric acid levels is only 33 percent. Usefulness has not been demonstrated for Doppler velocimetry of the uterine arteries in low-risk pregnant women.

What is the best treatment for preeclampsia? If the fetus is preterm and preeclampsia is mild, continued fetal and maternal evaluation is appropriate. The best tests for fetal evaluation have not been determined. The Working Group recommends weekly nonstress tests and/or biophysical profiles (repeated as indicated based on the woman's condition), twice-weekly testing if oligohydramnios or fetal growth restriction is suspected, and ultrasound examinations every three weeks. Daily assessment of fetal movement may be useful.

Laboratory tests for patients with mild preeclampsia and no progression include weekly platelet counts, liver enzyme levels, renal function evaluations, and protein levels (12- to 24-hour urine collection). If disease progression is in question, testing should be more frequent.

Pregnant women who are remote from term and have severe preeclampsia are best managed in a tertiary care center or in consultation with an obstetrician-gynecologist who has expertise in managing high-risk pregnancies. Daily laboratory tests and fetal surveillance may be needed.

Is outpatient management appropriate? The Working Group reports that hospitalization is frequently recommended for women with new-onset preeclampsia. After serial assessment, the setting for continued management can be determined. Hospitalization until delivery allows rapid intervention for complications.

Ambulatory management may be an option in women with mild gestational hypertension or preeclampsia who are remote from term. In these situations, frequent monitoring is required, and hospitalization is indicated if preeclampsia worsens. If compliance is a problem, women with disease progression or severe preeclampsia should be hospitalized.

Is medical management beneficial during labor and delivery? Significant evidence supports the use of magnesium sulfate to prevent seizures in women with severe preeclampsia and eclampsia. Antihypertensive drug therapy, most commonly with hydralazine or labetalol, is generally recommended for women with a diastolic pressure of 105 to 110 mm Hg (or higher). Hydralazine is given intravenously in 5-mg to 10-mg doses until the desired response is achieved. Labetalol is given as a 20-mg intravenous bolus, followed by 40 mg after 10 minutes if the first dose is not effective; then 80 mg is administered every 10 minutes (maximum total dose: 220 mg). e24fc04721