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12. Other conditions
– For moderate pre-eclampsia (hyp e r te ns ion + p r ote inu r ia )
•R e s t a nd obs e r v a tion, nor m a l s od iu m a nd c a lor ic inta ke .
•A ntihyp e r te ns iv e tr e a tm e nt if the s ys tolic B P is ≥ 1 6 0 m m H g or the
d ia s tolic B P is
≥1 1 0 m m H g, a s a bov e .
•A fte r 3 7 w e e ks , if the r e is a tr u e intr a u te r ine gr ow th r e ta r d a tion: d e liv e r y,
v a gina lly
or by c a e s a r e a n s e c tion d e p e nd ing on the c e r v ic a l a s s e s s m e nt. I f the r e is
no c le a r
gr ow th r e ta r d a tion, ind u c e d e liv e r y a s s oon a s the c e r v ix is fa v ou r a ble .
– For severe pre-eclampsia (hyp e r te ns ion + m a s s iv e p r ote inu r ia + m a jor
oe d e m a )
•R e fe r t o a s u r gic a l c e n tr e for u r ge n t d e liv e r y w ith in 2 4 h ou r s , v a gin a lly
or by
c a e s a r e a n s e c tion d e p e nd ing on the c e r v ic a l a s s e s s m e nt a nd the foe tu s
c ond ition.
•W hile w a iting for d e liv e r y, obs e r v a tion, nor m a l s od iu m a nd c a lor ic inta ke .
•A ntihyp e r te ns iv e tr e a tm e nt if the s ys tolic B P is ≥ 1 6 0 m m H g or the
d ia s tolic B P is
≥1 1 0 m m H g, a s a bov e . I f the tr e a tm e nt c a nnot be a d m inis te r e d by or a l
r ou te , u s e :
hydralazine by IV infu s ion:
D ilu te 1 0 0 m g (5 v ia ls of hyd r a la zine , 5 m l) in 5 0 0 m l of 0 .9 % s od iu m
c hlor id e or
R inge r la c ta te , to obta in a s olu tion c onta ining 2 0 0 m ic r ogr a m s / m l.
I n it ia l d os e : 2 0 0 t o 3 0 0 m ic r og r a m s / m in u t e ; m a in t e n a n c e d os e :
5 0 to
1 5 0 m ic r ogr a m s / m inu te .
A d m inis te r by inc r e a s ing the r a te u p to 2 0 d r op s / m inu te (m a x. 3 0
d r op s / m inu te ),
c he c k B P e v e r y 5 m inu te s .
A s s oon a s hyp e r te ns ion is c ontr olle d , d e c r e a s e p r ogr e s s iv e ly the r a te
(1 5 d r op s /
m inu te , the n 1 0 , the n 5 ) u ntil s top p ing infu s ion. A n a br u p t d is c ontinu a tion
m ay
p r ov oke a hyp e r te ns iv e c r is is .
or hydralazine by s low , d ilu te d IV inje c tion:
D ilu te 2 0 m g (1 v ia l hyd r a la zine , 1 m l) in 9 m l of 0 .9 % s od iu m c hlor id e to
obta in a
s olu tion c onta ining 2 m g/ m l.
A d m inis te r 5 m g (2 .5 m l of the d ilu te d s olu tion) ov e r 2 to 4 m inu te s .
C he c k B P for
2 0 m in u te s . I f B P is not c on tr olle d a fte r 2 0 m in u te s , a d m inis te r th e
s a m e d os e .
C on t in u e r e p e a t in g if n e c e s s a r y, w a it in g 2 0 m in u t e s be t w e e n e a c h
in je c t ion ,
w ithou t e xc e e d ing a c u m u la tiv e d os e of 2 0 m g.
or labetalol (1 0 0 m g in 2 0 m l a m p ou le , 5 m g/ m l) s low I V :
O ne d os e of 2 0 m g (4 m l) ov e r a t le a s t one m inu te . C he c k B P 5 a nd 1 0
m inu te s a fte r
inje c tion. If B P is not c ontr olle d , a d m inis te r a nothe r d os e of 2 0 m g a nd
c he c k B P .
A d d itiona l d os e s of 4 0 m g, the n 8 0 m g the n 1 6 0 m g m a y be
– For moderate pre-eclampsia (hyp e r te ns ion + p r ote inu r ia )
•R e s t a nd obs e r v a tion, nor m a l s od iu m a nd c a lor ic inta ke .
•A ntihyp e r te ns iv e tr e a tm e nt if the s ys tolic B P is ≥ 1 6 0 m m H g or the
d ia s tolic B P is
≥1 1 0 m m H g, a s a bov e .
•A fte r 3 7 w e e ks , if the r e is a tr u e intr a u te r ine gr ow th r e ta r d a tion: d e liv e r y,
v a gina lly
or by c a e s a r e a n s e c tion d e p e nd ing on the c e r v ic a l a s s e s s m e nt. I f the r e is
no c le a r
gr ow th r e ta r d a tion, ind u c e d e liv e r y a s s oon a s the c e r v ix is fa v ou r a ble .
– For severe pre-eclampsia (hyp e r te ns ion + m a s s iv e p r ote inu r ia + m a jor
oe d e m a )
•R e fe r t o a s u r gic a l c e n tr e for u r ge n t d e liv e r y w ith in 2 4 h ou r s , v a gin a lly
or by
c a e s a r e a n s e c tion d e p e nd ing on the c e r v ic a l a s s e s s m e nt a nd the foe tu s
c ond ition.
•W hile w a iting for d e liv e r y, obs e r v a tion, nor m a l s od iu m a nd c a lor ic inta ke .
•A ntihyp e r te ns iv e tr e a tm e nt if the s ys tolic B P is ≥ 1 6 0 m m H g or the
d ia s tolic B P is
≥1 1 0 m m H g, a s a bov e . I f the tr e a tm e nt c a nnot be a d m inis te r e d by or a l
r ou te , u s e :
hydralazine by IV infu s ion:
D ilu te 1 0 0 m g (5 v ia ls of hyd r a la zine , 5 m l) in 5 0 0 m l of 0 .9 % s od iu m
c hlor id e or
R inge r la c ta te , to obta in a s olu tion c onta ining 2 0 0 m ic r ogr a m s / m l.
I n it ia l d os e : 2 0 0 t o 3 0 0 m ic r og r a m s / m in u t e ; m a in t e n a n c e d os e :
5 0 to
1 5 0 m ic r ogr a m s / m inu te .
A d m inis te r by inc r e a s ing the r a te u p to 2 0 d r op s / m inu te (m a x. 3 0
d r op s / m inu te ),
c he c k B P e v e r y 5 m inu te s .
A s s oon a s hyp e r te ns ion is c ontr olle d , d e c r e a s e p r ogr e s s iv e ly the r a te
(1 5 d r op s /
m inu te , the n 1 0 , the n 5 ) u ntil s top p ing infu s ion. A n a br u p t d is c ontinu a tion
m ay
p r ov oke a hyp e r te ns iv e c r is is .
or hydralazine by s low , d ilu te d IV inje c tion:
D ilu te 2 0 m g (1 v ia l hyd r a la zine , 1 m l) in 9 m l of 0 .9 % s od iu m c hlor id e to
obta in a
s olu tion c onta ining 2 m g/ m l.
A d m inis te r 5 m g (2 .5 m l of the d ilu te d s olu tion) ov e r 2 to 4 m inu te s .
C he c k B P for
2 0 m in u te s . I f B P is not c on tr olle d a fte r 2 0 m in u te s , a d m inis te r th e
s a m e d os e .
C on t in u e r e p e a t in g if n e c e s s a r y, w a it in g 2 0 m in u t e s be t w e e n e a c h
in je c t ion ,
w ithou t e xc e e d ing a c u m u la tiv e d os e of 2 0 m g.
or labetalol (1 0 0 m g in 2 0 m l a m p ou le , 5 m g/ m l) s low I V :
O ne d os e of 2 0 m g (4 m l) ov e r a t le a s t one m inu te . C he c k B P 5 a nd 1 0
m inu te s a fte r
inje c tion. If B P is not c ontr olle d , a d m inis te r a nothe r d os e of 2 0 m g a nd
c he c k B P .
A d d itiona l d os e s of 4 0 m g, the n 8 0 m g the n 1 6 0 m g m a y be
