Oliguria Definition Adults

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Emergent Therapy for Acute- Onset, Severe Hypertension During Pregnancy and the Postpartum Period. Recommendations and Conclusions. The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions: Introducing standardized, evidence- based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Pregnant women or women in the postpartum period with acute- onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Close maternal and fetal monitoring by a physician and nursing staff are advised during the treatment of acute- onset, severe hypertension. After initial stabilization, the team should monitor blood pressure closely and institute maintenance therapy as needed.

  1. This Committee Opinion provides guidelines for emergency treatment of acute-onset, severe hypertension during pregnancy and postpartum.
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Intravenous (IV) labetalol and hydralazine have long been considered first- line medications for the management of acute- onset, severe hypertension in pregnant women and women in the postpartum period. Immediate release oral nifedipine also may be considered as a first- line therapy, particularly when IV access is not available.

The use of IV labetalol, IV hydralazine, or immediate release oral nifedipine for the treatment of acute- onset, severe hypertension for pregnant or postpartum patients does not require cardiac monitoring. In the rare circumstance that IV bolus labetalol, hydralazine, or immediate release oral nifedipine fails to relieve acute- onset, severe hypertension and is given in successive appropriate doses, emergent consultation with an anesthesiologist, maternal–fetal medicine subspecialist, or critical care subspecialist to discuss second- line intervention is recommended. Vietnamese Dating Etiquette.

Risk reduction and successful, safe clinical outcomes for women with preeclampsia or eclampsia require appropriate and prompt management of severe systolic and severe diastolic hypertension (1). Integrating standardized order sets into everyday safe practice in the United States is a challenge. Increasing evidence indicates that standardization of care improves patient outcomes (2). Introducing standardized, evidence- based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes (3, 4). With the advent of pregnancy hypertension guidelines in the United Kingdom, care of maternity patients with preeclampsia or eclampsia improved significantly, and maternal mortality rates decreased because of a reduction in cerebral and respiratory complications (5, 6).

Individuals and institutions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Treatment with first- line agents should be expeditious and occur as soon as possible within 3. Hg and persistent for 1. The use of checklists may be a useful tool to facilitate this process. This document revises Committee Opinion Number 6. Emergent Therapy for Acute- Onset, Severe Hypertension with Preeclampsia or Eclampsia, primarily to clarify the terminology around immediate release oral nifedipine and to clarify monitoring expectations during and after treatment of acute- onset, severe hypertension. Acute- onset, severe systolic (greater than or equal to 1.

Hg) hypertension; severe diastolic (greater than or equal to 1. Hg) hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. These conditions can occur in the second half of gestation in women not known to have chronic hypertension who develop sudden, severe hypertension (ie, with preeclampsia; gestational hypertension; or hemolysis, elevated liver enzymes, and low platelet count [HELLP] syndrome), but they also can occur among patients with chronic hypertension who are developing superimposed preeclampsia or a hypertensive exacerbation with acutely worsening, difficult to control, severe hypertension. Acute- onset, severe hypertension that is accurately measured using standard techniques and is persistent for 1. It is well known that severe hypertension can cause central nervous system injury. As stated in the Confidential Enquiries report from the United Kingdom, two thirds of the maternal deaths during 2.

The degree of systolic hypertension (as opposed to the level of diastolic hypertension or relative increase or rate of increase of mean arterial pressure from baseline levels) may be the most important predictor of cerebral injury and infarction. In a case series of 2. A similar relationship between severe systolic hypertension and risk of hemorrhagic stroke has been observed in nonpregnant adults (1. Thus, systolic blood pressure (BP) of 1. Hg or greater should be included as part of the definition of severe hypertension in pregnant women or women in the postpartum period (1.

Accurate measurement of blood pressure is necessary to optimally manage hypertension in pregnancy. Best Place To Live In North Carolina For Young Adults.