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Hypertension in Pregnancy Treatment

You may recall seeing the case of Paula Rice of St. Petersburg, Florida who got hypertension late in her pregnancy. It was diagnosed  her 3rd trimester. And it was complicated by a mild intracerebral hemorrhage.

Her doctor had some important choices to make. Fortunately Dr. Reynolds was able to sort things out and things turned out alright for mom and baby.

The treatments that Dr. Reynolds had to choose from included medication, hospitalization and early delivery of the baby through pitosin or C-section.

Several types of treatment are still considered even though there is no proof that they work. Those include restricting activity and dietary changes. Supplemental calcium, salt restriction, supplemental magnesium, and fish oil therapy have been tried without evidence of helping. There is some evidence that low dose aspirin does help.

Medicines used for hypertension in pregnancy include Alpha-adrenergic inhibitors such as Methyldopa (Aldomet), Beta-adrenergic receptor blockers such as Labetalol (Normodyne, Trandate), Pindolol (Visken), Oxprenolol (Apsolox, Trasicor, Captol), Metoprolol (Lopressor, Toprol XL) and Atenolol (Tenormin), Calcium channel blockers like Nifedipine (Adalat, Procardia), Vasodilators like Nitroprusside (Nitropress) and Hydralazine (Apresoline) and Anticonvulsants like (Phenytoin (Dilantin) and Magnesium sulfate.

The Alpha-adrenergic inhibitors are probably the safest during pregnancy and are usually the first medication most doctors would use. If there is an allergy to the medicine or liver problems it is not as safe. But, there has not been any studies that show any harm to the baby.

Beta-adrenergic receptor blockers include some medications that are very safe and some not quite as safe. The safe ones can also be the first choice for treatment.

Calcium channel blockers may not be as safe. They have been labled 'C' because their safety for use in pregnancy has not been proven.

Centrally acting alpha-adrenergic agonists are usually saved for use in those that can't take the more frequently used medications. Like the calcium channel blockers, it has not been proven safe in pregnancy. (However, that does not mean they should not be used - but you should discuss it with your doctor.)

Diuretics also have a 'C' rating so their use is limited to cases where your doctor has determined that other safer drugs cannot be used and your high blood pressure is dangerous to you or your baby.

Vasodilators have to be given intravenously so are restricted to in hospital use. Therefore, you have to have pretty bad hypertension problems to have these used.

The seizure medications include the only medication in the group with an 'A' rating meaning that it is absolutely safe in pregnancy. That is magnesium sulfate. This is used in women who have severe pregnancy induced hypertension (eclampsia or preeclampsia) to prevent any dangerous seizures.

Naturally, any of these medications need to be used under your doctor's care and close monitoring will be required.

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