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For a comprehensive overview of these recommendations, the full-text Scan this QR code
version of this Practice Bulletin is available at http://dx.doi.org/10.1097/ with your smartphone
AOG.0000000000003018. to view the full-text
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Practice Bulletin.
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Committee on Practice Bulletins—Obstetrics. This Practice Bulletin was developed by the American College of Obstetricians and
Gynecologists’ Committee on Practice Bulletins—Obstetrics in collaboration with Jimmy Espinoza, MD, MSc; Alex Vidaeff, MD,
MPH; Christian M. Pettker, MD; and Hyagriv Simhan, MD.
concentration in the absence of other renal disease); 4. Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates
pulmonary edema, or new-onset headache unre- in the United States, 1980-2010: age-period-cohort analy-
sis. BMJ 2013;347:f6564.
sponsive to acetaminophen and not accounted for by
alternative diagnoses, or visual disturbances. 5. Stevens W, Shih T, Incerti D, Ton TGN, Lee HC, Peneva
D, et al. Short-term costs of pre-eclampsia to the United
< Women with gestational hypertension who present States health care system. Am J Obstet Gynecol 2017;217:
with severe-range blood pressures should be man- 237–48.e16.
aged with the same approach as for women with
severe preeclampsia.
< Among women with gestational hypertension or
preeclampsia without severe features, expectant
Studies were reviewed and evaluated for quality
management up to 37 0/7 weeks of gestation is rec- according to the method outlined by the U.S.
ommended, during which frequent fetal and maternal Preventive Services Task Force. Based on the highest
evaluation is recommended. Fetal monitoring con- level of evidence found in the data, recommendations are
sists of ultrasonography to determine fetal growth provided and graded according to the following
every 3–4 weeks of gestation, and amniotic fluid categories:
volume assessment at least once weekly. In addition, Level A—Recommendations are based on good and
consistent scientific evidence.
an antenatal test one-to-two times per week for pa-
tients with gestational hypertension or preeclampsia Level B—Recommendations are based on limited or
inconsistent scientific evidence.
without severe features is recommended.
Level C—Recommendations are based primarily on
< Epidural or spinal anesthesia is considered acceptable, consensus and expert opinion.
and the risk of epidural hematoma is exceptionally low,
in patients with platelet counts 70 3 109/L or more Full-text document published online on December 20, 2018.
provided that the platelet level is stable, there is no
other acquired or congenital coagulopathy, the platelet Copyright 2018 by the American College of Obstetricians and
function is normal, and the patient is not on any anti- Gynecologists. All rights reserved. No part of this publication
platelet or anticoagulant therapy. may be reproduced, stored in a retrieval system, posted on the
Internet, or transmitted, in any form or by any means, elec-
tronic, mechanical, photocopying, recording, or otherwise,
without prior written permission from the publisher.
References
1. Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Requests for authorization to make photocopies should be
Pre-eclampsia. Lancet 2010;376:631–44. directed to Copyright Clearance Center, 222 Rosewood Drive,
Danvers, MA 01923, (978) 750-8400.
2. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look
PF. WHO analysis of causes of maternal death: a systematic American College of Obstetricians and Gynecologists
review. Lancet 2006;367:1066–74. 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920
3. Wallis AB, Saftlas AF, Hsia J, Atrash HK. Secular trends Official Citation
in the rates of pre-eclampsia, eclampsia, and gestational Gestational hypertension and preeclampsia. ACOG Practice
hypertension, United States, 1987-2004. Am J Hypertens Bulletin No. 202. American College of Obstetricians and Gy-
2008;21:521–6. necologists. Obstet Gynecol 2019;133:e1–25.
VOL. 133, NO. 1, JANUARY 2019 Practice Bulletin No. 202 Summary 213