Abstract
Hypertensive disorders are the most common medical complications of pregnancy and
a major cause of maternal and perinatal morbidity and death. The detection of elevated
blood pressure during pregnancy is one of the cardinal aspects of optimal antenatal
care. With the outbreak of novel coronavirus disease 2019 (COVID-19) and the risk
for person-to-person spread of the virus, there is a desire to minimize unnecessary
visits to health care facilities. Women should be classified as low risk or high risk
for hypertensive disorders of pregnancy and adjustments can be accordingly made in
the frequency of maternal and fetal surveillance. During this pandemic, all pregnant
women should be encouraged to obtain a sphygmomanometer. Patients monitored for hypertension
as an outpatient should receive written instructions on the important signs and symptoms
of disease progression and provided contact information to report the development
of any concern for change in status. As the clinical management of gestational hypertension
and preeclampsia is the same, assessment of urinary protein is unnecessary in the
management once a diagnosis of a hypertensive disorder of pregnancy is made. Pregnant
women with suspected hypertensive disorders of pregnancy and signs and symptoms associated
with the severe end of the disease spectrum (e.g., headaches, visual symptoms, epigastric
pain, and pulmonary edema) should have an evaluation including complete blood count,
serum creatinine level, and liver transaminases (aspartate aminotransferase and alanine
aminotransferase). Further, if there is any evidence of disease progression or if
acute severe hypertension develops, prompt hospitalization is suggested. Current guidelines
from the American College of Obstetricians and Gynecologists (ACOG) and The Society
for Maternal-Fetal Medicine (SMFM) for management of preeclampsia with severe features
suggest delivery after 34 0/7 weeks of gestation. With the outbreak of COVID-19, however, adjustments to this algorithm
should be considered including delivery by 30 0/7 weeks of gestation in the setting of preeclampsia with severe features.
Key Points
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Outbreak of novel coronavirus disease 2019 (COVID-19) warrants fewer office visits.
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Women should be classified for hypertension risk in pregnancy.
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Earlier delivery suggested with COVID-19 and hypertensive disorder.
Keywords
preeclampsia - hypertension in pregnancy - coronavirus - COVID-19
