Interventions for Hypertensive Disorders in Pregnancy

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Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Provide information/create awareness on the symptoms and preventive measures of hypertension and hypertensive diseases of pregnancy Engage male partners in RMNCH issues * Engage families in dialogue to identify barriers and negotiate actions to RMNCH issues	Regular ANC attendance -to receive antenatal education to make them aware of the symptoms associated with pre-eclampsia, its importance and the need to obtain medical care Advice to pregnant women to seek urgent medical advice if they experience symptoms preeclampsia/eclampsia Calcium supplementation to all women especially high-risk women and populations with low dietary calcium intake * Low-dose aspirin in women at high risk of preeclampsia		Recognition of symptoms associated with hypertension in pregnancy Administer antihypertensive medicines and immediate referral to the next level
Primary Care
Provide information/create awareness on the symptoms and preventive measures of hypertension and hypertensive diseases of pregnancy Engage male partners in RMNCH issues * Engage families in dialogue to identify barriers and negotiate actions to RMNCH issues	Antenatal education to pregnant women so that they are aware of the symptoms associated with pre-eclampsia, Advice to pregnant women to seek medical advice if they experience symptoms such as severe headache: blurred vision or flashing before the eyes, vomiting, sudden swelling of the face, hands or feet. Guidance on low salt intake (less use of seasoning) Guidance on physical activities and physical exercises Advice on the need for adequate rest-including adequate sleep Avoidance of smoking tobacco Cessation of alcohol use Maintaining a healthy body weight Monitor blood pressure and cholesterol levels Screening for high blood pressure, Screening for diabetes mellitus		Recognition of symptoms associated with hypertension in pregnancy Administer antihypertensive medicines and close monitoring of blood pressure and foetal heart Close monitoring to signs of stroke, epigastric and RUQ pain * Pharmacological management of eclampsia Corticosteroids to pregnant woman of gestational age less than or equal to 32 weeks Immediate referral to the next level if patient fails to respond to treatment
Referral Facility: General
Provide information/create awareness on the symptoms and preventive measures of hypertension and hypertensive diseases of pregnancy * Engage male partners in RMNCH issues * Engage families in dialogue to identify barriers and negotiate actions to RMNCH issues	Antenatal education to pregnant women so that they are aware of the symptoms associated with pre-eclampsia, Advice to pregnant women to seek medical advice if they experience symptoms of preeclampsia Guidance on low sodium intake (less seasoning) Guidance on Physical activities and physical exercises Advice on the need for adequate rest-including adequate sleep Avoidance of smoking tobacco Cessation of alcohol use Maintaining a healthy body weight Monitor blood pressure and cholesterol levels Screening for high blood pressure, Screening for diabetes mellitus		Basic laboratory test Advanced laboratory Ultrasound examination of the eyes or fundoscopy * Management of gestational hypertension or pre-existing hypertension in pregnant Pharmacological management Non-pharmacological management including close supervision, advice on limitation of activities, and some bed rest Use of dietetic management Review of medication accordingly for mother with pre-existing hypertension Close monitoring of blood pressure, urine output, total protein & proteinuria, renal function tests Monitoring foetal heart and foetal growth Terminate pregnancy if patient fails to respond to treatment post-natal monitoring
Referral Facility: Specialist
Provide information/create awareness on the symptoms and preventive measures of hypertension and hypertensive diseases of pregnancy Engage male partners in RMNCH issues * Engage families in dialogue to identify barriers and negotiate actions to RMNCH issues	Low-dose aspirin for women with high risk for preeclampsia * High-dose calcium supplementation for women at risk of hypertensive disorders and those with low-calcium diets.		Basic laboratory test Advanced laboratory tests Ultrasound examination of the eyes or fundoscopy * Management of gestational hypertension or pre-existing hypertension in pregnant women based on severity and gestational age *Pharmacological management Non-pharmacological management including close supervision, advice on limitation of activities, and some bed rest Use of dietetic management Review of medication accordingly for mother with pre-existing hypertension Close monitoring of blood pressure, urine output, total protein & proteinuria, renal function tests Monitoring foetal heart and foetal growth Terminate pregnancy if patient fails to respond to treatment post-natal monitoring

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Provide information/create awareness on the symptoms and preventive measures of hypertension and hypertensive diseases of pregnancy * Engage male partners in RMNCH issues * Engage families in dialogue to identify barriers and negotiate actions to RMNCH issues	Regular ANC attendance -to receive antenatal education to make them aware of the symptoms associated with pre-eclampsia, its importance and the need to obtain medical care Advice to pregnant women to seek urgent medical advice if they experience symptoms of preeclampsia/eclampsia		Recognition of symptoms associated with hypertension in pregnancy * Administer antihypertensive medicines and immediate referral to the next level
Primary Care
Provide information/create awareness on the symptoms and preventive measures of hypertension and hypertensive diseases of pregnancy * Engage male partners in RMNCH issues * Engage families in dialogue to identify barriers and negotiate actions to RMNCH issues	Antenatal education to pregnant women so that they are aware of the symptoms associated with pre-eclampsia, Advice to pregnant women to seek urgent medical advice if they experience symptoms of preeclampsia/eclampsia Life style changes (low salt intake, exercise, rest, avoiding alcohol drink and tobacco) Regular monitoring blood pressure, urine protein and blood sugars		Recognition of symptoms associated with hypertension in pregnancy Administer antihypertensive medicines and close monitoring of blood pressure and foetal heart * Close monitoring to signs of stroke, epigastric and RUQ pain * Pharmacological management of eclampsia Corticosteroids to pregnant woman of gestational age less than or equal to 32 weeks Immediate referral to the next level if patient fails to respond to treatment
Referral Facility: General
	Regular monitoring of blood pressure, urine protein and blood sugars for all pregnant women		History and physical examination Basic laboratory test Advanced laboratory tests Basic imaging: ultrasound Ultrasound examination of the eyes or fundoscopy Non-pharmacological management including close supervision, advice on limitation of activities, bed rest, diet, etc Pharmacological management of gestational hypertension or pre-existing hypertension in pregnant women Review of medication accordingly for mother with pre-existing hypertension Close monitoring of blood pressure, urine output, total protein & proteinuria, renal function tests Monitoring foetal heart and foetal growth Terminate pregnancy if patient fails to respond to medical treatment Post-natal monitoring of mother and neonate
Referral Facility: Specialist
	Low-dose aspirin for women with high risk for preeclampsia * High-dose calcium supplementation for women at risk of hypertensive disorders and those with low-calcium diets.		History and physical examination Basic laboratory test Advanced laboratory tests Basic imaging: ultrasound Ultrasound examination of the eyes or fundoscopy Non-pharmacological management including close supervision, advice on limitation of activities, bed rest, diet, etc Pharmacological management of gestational hypertension or pre-existing hypertension in pregnant women Review of medication accordingly for mother with pre-existing hypertension Close monitoring of blood pressure, urine output, total protein & proteinuria, renal function tests Monitoring foetal heart and foetal growth Terminate pregnancy if patient fails to respond to medical treatment Post-natal monitoring of mother and neonate

Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community awareness and engagement for identification of danger signs of pregnancy including symptoms of hypertensive disorders of pregnancy Engagement of male partners and family members	Regular ANC attendance Delivery in health facility * Timely referral of high-risk pregnant women Promote use of maternity waiting homes for high-risk pregnant women	Recognition of signs and symptoms	Immediate transfer to a higher-level health care facility		Psychosocial support for physical and emotional recovery
Primary Care
Health education on danger signs of pregnancy including symptoms of hypertensive disorders of pregnancy	Provision of quality ANC Delivery in health facility * Timely referral of high-risk pregnant women	History Physical examination Complete blood cell (CBC) count Urine protein test	Magnesium sulphate loading dose Immediate transfer to a higher-level health care facility		Psychosocial support for physical and emotional recovery
Referral Facility: General
Health education on danger signs of pregnancy including symptoms of hypertensive disorders of pregnancy	Prophylactic Low-dose acetylsalicylic acid for high-risk pregnant women Calcium supplementation during pregnancy Antihypertensive drugs for pregnant women with hypertension Prophylactic magnesium sulphate	History Physical examination Urine protein test Complete blood cell (CBC) count Liver function test Renal function test Uric acid Ultrasound	Vital signs monitoring Expedited delivery for women remote from term Magnesium sulphate, full regimen Antihypertensive drugs Antihypertensive drugs during the postpartum period		Psychosocial support for physical and emotional recovery
Referral Facility: Specialist
Health education on danger signs of pregnancy including symptoms of hypertensive disorders of pregnancy	Prophylactic Low-dose acetylsalicylic acid for high-risk pregnant women Calcium supplementation during pregnancy Antihypertensive drugs for pregnant women with hypertension Prophylactic magnesium sulphate	History Physical examination Urine protein test Complete blood cell (CBC) count Liver function test Renal function test Uric acid Ultrasound	• Vital signs monitoring • Expedited delivery for women remote from term • Magnesium sulphate, full regimen • Antihypertensive drugs • Antihypertensive drugs during the postpartum period		Psychosocial support for physical and emotional recovery