Women prefer out-of-hospital GS-1101 supplier care. Home care. Eligibility is ⩽25% . Eligibility criteria vary widely but include accurate BP self-measurement (HBPM) , and consistency between home and hospital BP . In observational studies, home care has been variably defined in terms of activity levels, self- vs. nurse/midwife assessments, and means of communication;  and  all involved daily contact and a (usually) weekly outpatient visit ,  and . No RCTs have compared antepartum home care with either hospital day or inpatient care. For gestational hypertension, routine activity
at home (vs. some bed rest in hospital) is associated with more severe hypertension (RR 1.72; 95% CI 1.12–2.63) and preterm birth (RR 1.89; 95% CI 1.01–3.45); GSK J4 cost women prefer routine activity at home  and . In observational studies of antepartum home care (vs. inpatient care), hospital admission (25%) , re-admission (44%)  and maternal satisfaction rates  were high, with similar outcomes for either gestational hypertension , or mild preeclampsia . Costs were lower with home care . For severe hypertension (BP of ⩾160 mmHg systolic or ⩾110 mmHg diastolic) 1. BP should be lowered to <160 mmHg systolic and <110 mmHg diastolic (I-A; Low/Strong). BP ⩾160/110 mmHg should be confirmed after 15 min. Most
women will have preeclampsia, and were normtensive recently.
These hypertensive events out are ‘urgencies’ even without symptoms. In the 2011 World Health Organization (WHO) preeclampsia/eclampsia recommendations, antihypertensive treatment of severe hypertension was strongly recommended to decrease maternal morbidity and mortality . Severe systolic hypertension is an independent risk factor for stroke in pregnancy . Short-acting antihypertensives successfully lower maternal BP in ⩾80% of women in RCTs of one antihypertensive vs. another (see below). Finally, the UK ‘Confidential Enquiries into Maternal Deaths’ identified failure to treat the severe (particularly systolic) hypertension of preeclampsia as the single most serious failing in the clinical care of women who died  and . A hypertensive ‘emergency’ is associated with end-organ complications (e.g., eclampsia). Extrapolating from outside pregnancy, hypertensive emergencies require parenteral therapy (and arterial line) aimed at lowering mean arterial BP by no more than 25% over minutes to hours, and then further lowering BP to 160/100 mmHg over hours. Hypertensive ‘urgencies’ are without end-organ complications and may be treated with oral agents with peak drug effects in 1–2 h (e.g., labetalol). Gastric emptying may be delayed or unreliable during active labour. Recommendations have been restricted to antihypertensive therapy widely available in Canada.