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Objective: To map the diverse scientific evidence on nursing diagnoses and interventions in women with pregnancy hypertensive disorders under Primary Health Care. Materials and method: A scoping review was conducted through nine stages in seven databases and the thesis and dissertation catalog of the Coordinating Office for Improving Higher Education Personnel. The search was performed from January to March 2021. Results: A total of 2,505 articles were retrieved, of which five were included in the final review. Nine primary diagnoses from the 2009-2011 version of NANDA-I were identified. Each diagnosis was classified according to physical, psychological, behavioral, and environmental characteristics. The interventions were related to controlling pain, anxiety, hemodynamic dysfunctions, self-esteem level, fluid replacement, patient/environment hygiene, and sleep-rest ratio. Conclusions: The nursing diagnoses and interventions presented in this study corroborate the clinical practice and aid nursing professionals' reasoning. Resumen Objetivo: mapear las evidencias científicas acerca de los diagnósticos e intervenciones de enfermería en mujeres con hipertensión inducida en el embarazo en la atención primaria de salud. Materiales y método: scoping review en nueve etapas, en siete bases de datos y en el catálogo de tesis de la Coordinación de Perfeccionamiento de Nivel Superior de Brasil. Se realizó la búsqueda de enero a marzo de 2021. Resultados: se recopilaron 2505 artículos, de los cuales cinco se excluyeron en la revisión final. Nueve diagnósticos principales de la versión 2009-2011 de la NANDA-I. Se clasificó cada diagnóstico en cuanto a las características físicas, psicológicas, comportamentales y ambientales. Las intervenciones se relacionaron con el control del dolor, de la ansiedad, de las disfunciones hemodinámicas, del nivel de autoestima, de la reposición hídrica, de la higienización del paciente/ambiente y a la relación sueño-reposo. Conclusiones: los diagnósticos e intervenciones de enfermería presentados en el estudio corroboran la práctica clínica y auxilian en el razonamiento del profesional de enfermería. Resumo Objetivo: mapear as evidências científicas sobre os diagnósticos e intervenções de enfermagem em mulheres com distúrbios hipertensivos da gravidez na atenção primária à saúde. Materiais e método: scoping review em nove etapas, em sete bases de dados e no catálogo de teses e dissertações da Coordenação de Aperfeiçoamento de Nível Superior. Realizou-se a busca de janeiro a março de 2021. Resultados: 2505 artigos foram recuperados, dos quais cinco foram incluídos na revisão final. Nove diagnósticos principais da versão 2009-2011 da NANDA-I. Classificou-se cada diagnóstico quanto às características físicas, psicológicas, comportamentais e ambientais. As intervenções foram relacionadas ao controle da dor, da ansiedade, das disfunções hemodinâmicas, do nível de autoestima, da reposição hídrica, da limpeza do paciente/ambiente e à relação sono-repouso. Conclusões: os diagnósticos e intervenções de enfermagem apresentados neste estudo corroboram a prática clínica e auxiliam no raciocínio do profissional de enfermagem.

The pregnancy-specific hypertensive syndrome (PSHS) is one of the main causes of maternal-fetal mortality. The professional who establishes a bond with the pregnant woman and monitors prenatal, childbirth and postpartum care must know the risk factors that affect the health of the woman and the baby, allowing the planning of care aimed at preventing complications. The aim of this study is to identify the risk factors, complications and the nursing performance in PSHS and to list the main diagnoses, goals and nursing interventions. This is a systematic review, whose sample was composed of 14 articles. A profile of the pregnant woman most at risk for the onset of PSHS was then outlined, and characteristics such as maternal age, socioeconomic conditions, level of education, ethnicity, personal and family history, and obstetric history were defined. Maternal and perinatal complications were identified. The nursing performance is evidenced by early detection actions, evaluation of risk factors, and encouragement of therapeutic adherence. Furthermore, diagnosis, goals, and nursing interventions operationalize care in PSHS. Although the number of publications is scarce, the study considers clear in the literature the description of risk factors for the emergence of PSHS and its main complications. These aspects are the basis for the nursing performance that will work in the identification of these risk factors, monitoring of signs and symptoms, prevention of diseases, and welcoming pregnant women and their families. La síndrome hipertensivo específico del embarazo (SHEE) es una de las principales causas de mortalidad materno-fetal. El profesional que establece vínculo con la gestante y acompaña la atención prenatal, parto y puerperio tende a conocer los factores de riesgo que afectan la salud de la mujer y del bebé, permitiendo la planificación de la asistencia dirigida a la prevención de complicaciones. El objetivo de este estudio es identificar los factores de riesgo, complicaciones y la actuación de enfermería en SHEE y enumerar los principales diagnósticos, metas y intervenciones de enfermería. Se trata de una revisión sistemática, cuya muestra estuvo compuesta por 14 artículos. A partir de ahí, se delineó un perfil de la gestante con mayor riesgo y se definieron características como edad materna, condiciones socioeconómicas, nivel educativo, etnia, antecedentes personales, familiares y antecedentes obstétricos. Se identificaron complicaciones maternas y perinatales. La actuación de la enfermería se evidencia por las acciones de detección precoz, evaluación de factores de riesgo y incentivo a la adherencia terapéutica. Además, los diagnósticos, metas y intervenciones de enfermería operacionalizan la asistencia en la SHEE. Finalmente, aunque el número de publicaciones es escaso, el estudio considera que la descripción de los factores de riesgo para la aparición de SHEE y sus principales complicaciones es clara en la literatura. Estos aspectos son la base para la actuación de enfermería que actuará en la identificación de estos factores de riesgo, seguimiento de signos y síntomas, prevención de agravios y acogida de la gestante y su familia. A Síndrome Hipertensiva Específica da Gravidez (SHEG) é uma das principais causas de mortalidade materno-fetal. O profissional que estabelece vínculo com a gestante e acompanha o pré-natal, parto e pós-parto deve conhecer os fatores de risco que afetam a saúde da mulher e do bebê, permitindo o planejamento da assistência visando a prevenção de complicações. O objetivo deste estudo é identificar os fatores de risco, complicações e a atuação de enfermagem nas SHEG e elencar os principais diagnósticos, metas e intervenções de enfermagem. Trata-se de uma revisão sistemática, cuja amostra foi composta por 14 artigos. A partir de então, foi delineado um perfil da gestante com maior risco para o surgimento das SHEG e definido características como, idade materna, condições socioeconômicas, nível de escolaridade, etnia, antecedentes pessoais e familiares e histórico obstétrico. Foram identificadas complicações maternas e perinatais. A atuação de enfermagem é evidenciada pelas ações de detecção precoce, avaliação dos fatores de risco e incentivo à adesão terapêutica. Além disso, os diagnósticos, metas e intervenções de enfermagem operacionalizam a assistência nas SHEG. Embora o número de publicações seja escasso, o estudo considera claro na literatura a descrição dos fatores de risco para o surgimento das SHEG e suas principais complicações. Estes aspectos fundamentam a atuação de enfermagem que atuará na identificação destes fatores de risco, monitoração dos sinais e sintomas, prevenção de agravos e acolhimento da gestante e família.

ANTECEDENTES Y JUSTIFICACIÓN La preeclampsia (PE) es una de las principales causas de morbilidad y mortalidad materna y fetal que afecta del 2 al 10 % de los embarazos. La administración profiláctica de aspirina reduce la incidencia de PE pretérmino (edad gestacional al momento del parto < 37 semanas) y las complicaciones asociadas, por lo que la identificación temprana de embarazos de alto riesgo es clave para reducir la carga de PE al permitir la orientación precisa de la aspirina profiláctica. La importancia del problema de salud y la existencia de un tratamiento preventivo, han llevado a recomendar el cribado de PE en el primer trimestre de gestación. Sin embargo, existe incertidumbre sobre la prueba más adecuada para el cribado. Una de las pruebas propuestas es el algoritmo de la FMF, desarrollado y validado principalmente en poblaciones procedentes del Reino Unido. Es fundamental establecer si el algoritmo presenta rendimientos diagnósticos similares en poblaciones diferentes a las que sirvieron para su diseño. OBJETIVO Valorar el rendimiento del algoritmo de la Fetal Medicine Foundation (FMF) como prueba de cribado de preeclampsia durante el primer trimestre de gestación en diferentes poblaciones de mujeres no seleccionadas con embarazo de un solo feto. MATERIALES Y MÉTODOS Se ha llevado a cabo una revisión sistemática de la literatura, con búsquedas bibliográficas en las bases de datos MedLine, Embase y Cochrane Library, hasta julio y agosto de 2021. Se ha realizado una lectura crítica de los artículos seleccionados, con el fin de identificar los problemas metodológicos que pudieran influir en su validez. Se ha llevado a cabo la combinación estadística de los datos mediante un metanálisis para la estimación de los valores ponderados de los parámetros de validez diagnóstica. Se ha abordado cuatro metanálisis diferentes, atendiendo a cuatro modelos resultantes de la combinación de diferentes factores de riesgo utilizados en el algoritmo de predicción de la FMF y se examinó la robustez de los hallazgos mediante un análisis de sensibilidad. Los modelos estudiados fueron: Modelo 1: riesgo “a priori” [características maternas (CM)]. Modelo 2: MINI TEST [CM, el factor biofísico MAP y un factor bioquímico (PIGF o PAPP-A)]. Modelo 3: TRIPLE TEST [CM, los factores biofísicos (MAP y UtAPI) y un factor bioquímico (PIGF o PAPP-A)]. Modelo 3: CUÁDRUPLE TEST [CM, los factores biofísicos (MAP y UtAPI) y los factores bioquímicos (PIGF y PAPP-A)]. RESULTADOS La búsqueda bibliográfica ha permitido identificar 16 estudios prospectivos que valoraban el rendimiento diagnóstico del algoritmo de la FMF para el cribado de la PE pretérmino. Los 16 estudios incluidos han analizado poblaciones procedentes de 18 países diferentes de América, Australia, Europa y Asia; con un rango de prevalencia de PE pretérmino entre 0,44% y 2,92%. El algoritmo de la FMF mostró un rendimiento diagnóstico global aceptable para el “riego a priori” con AUC entre 0,736 y 0,790; y bueno para el Triple y Cuádruple Test con AUC entre 0,787-0,948 y 0,843 y 0,96, respectivamente. El riesgo individual y la exactitud con la que el algoritmo de la FMF clasificaba un embarazo se determinó mediante la tasa de detección; esta tasa se estimó en todos los casos estableciendo el 10% de falsos positivos como punto de corte. Utilizando únicamente las características maternas las tasas de detección observadas estaban entre 39%-58% y eran similares para la PE temprana (

RESUMEN Objetivos: Proveer recomendaciones clínicas basadas en evidencia para la prevención y el manejo de la enfermedad hipertensiva del embarazo (EHE) en el Seguro Social de Salud (EsSalud) del Perú. Materiales y métodos: se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló ocho preguntas clínicas para ser respondidas por la presente Guía de Práctica Clínica (GPC). Se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando se consideró pertinente, estudios primarios en PubMed y Central durante 2021. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas . En reuniones de trabajo periódicas, el GEG usó la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE) para calificar la evidencia y formular las recomendaciones. Además se resentan los puntos de buenas prácticas clínicas (BPC) y los flujogramas de prevención, manejo y seguimiento. Finalmente, la GPC fue aprobada por Resolución 112-IETSI-ESSALUD-2021. Resultados: En la presente GPC se formularon 11 recomendaciones (6 fuertes y 5 condicionales) que respondieron las preguntas clínicas definidas en el alcance de la GPC, acompañadas de 32 puntos de BPC y 3 flujogramas que abordan temas de prevención, tratamiento y seguimiento de la EHE. Conclusiones: Como recomendaciones centrales de la guía se dan el uso de sulfato de magnesio para el tratamiento de la preeclampsia severa y la eclampsia. La guía deberá ser actualizada en tres años. ABSTRACT Objectives: To provide clinical recommendations based on evidence for the prevention and management of Hypertensive disorders of pregnancy (HDP) in the Social Health Insurance (EsSalud) of Peru. Materials and methods: A CPG for the the prevention and management of HDP in EsSalud was developed. To this end, a guideline development group (local GDG) was established, including medical specialists and methodologists. The local GDG formulated 8 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when it was considered pertinent- primary studies were searched in PubMed y Central during 2021. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice and flowcharts for the prevention, management and follow-up. Finally, the CPG was approved with Resolution 112-IETSI-ESSALUD-2021. Results: This CPG addressed 8 clinical questions, divided into three topics: prevention, management and follow-up of the HDP. Based on these questions, 11 recommendations (6 strong recommendations and 5 weak recommendations), 32 points of good clinical practice, and 3 flowcharts were formulated. Conclusions: The main recommendations in the guideline are the use of magnesium sulfate for the treatment of severe pre-eclampsia and eclampsia. The guideline must be updated in three years' time.

Objective. To estimate the point prevalence and likely ranges of pregnancy-induced hypertension, preeclampsia, gestational diabetes, low birth weight and preterm delivery in Latin America and the Caribbean, and evaluate the heterogeneity of the estimates. Methods. We conducted a systematic review and meta-analysis of observational studies reporting the prevalence of maternal and perinatal adverse outcomes in populations in Latin American and the Caribbean published between 2000 and 2019 in English, Spanish, or Portuguese. We searched PubMed, Embase, and LILACS. We estimated the point prevalence and evaluated overall heterogeneity and, in sub-group analyses, heterogeneity by study design and level of bias. Results. Of 1087 records retrieved, 50 articles were included in the review: two on hypertensive disorders of pregnancy, 14 on pre-eclampsia, six on gestational diabetes, nine on low birth weight and 19 on preterm birth. No meta-analysis for hypertensive disorders of pregnancy could be done because of the small number of studies. Point prevalence estimates and 95% confidence intervals (CIs) for pre-eclampsia, gestational diabetes, low birth weight, and preterm birth were: 6.6% (95% CI: 4.9%, 8.6%), 8.5% (95% CI: 3.9%, 14.7%), 8.5% (95% CI: 7.2%, 9.8%), and 10.0% (95% CI: 8.0%, 12.0%), respectively. We observed substantial heterogeneity overall and by study design. No major differences in estimates were observed by level of bias. Conclusions. The results of this study provide updated estimates of some of the most prevalent adverse pregnancy and perinatal outcomes in Latin America and the Caribbean. They highlight that important heterogeneity exists in prevalence estimates, which may reflect the diversity of populations in the region. Objetivo. Estimar la prevalencia puntual y los rangos probables de hipertensión provocada por embarazo, preeclampsia, diabetes gestacional, peso bajo al nacer y parto prematuro en América Latina y el Caribe, y evaluar la heterogeneidad de las estimaciones. Métodos. Se llevó a cabo una revisión sistemática y metanálisis de los estudios de observación que notificaron la prevalencia de resultados adversos perinatales y maternos en poblaciones de América Latina y el Caribe, publicados entre los años 2000 y 2019 en inglés, español o portugués. Se realizaron búsquedas en PubMed, Embase y LILACS. Se estimó la prevalencia puntual y se evaluó la heterogeneidad general y, en los análisis de subgrupos, la heterogeneidad según el diseño del estudio y nivel de sesgo. Resultados. De 1 087 registros recuperados, se incluyeron 50 artículos en la revisión: 2 sobre los trastornos hipertensivos en el embarazo, 14 sobre preeclampsia, 6 sobre la diabetes gestacional, 9 sobre peso bajo al nacer y 19 sobre parto prematuro. No se pudo realizar ningún metanálisis de los trastornos hipertensivos del embarazo debido al número reducido de estudios. Las estimaciones de prevalencia puntual y los intervalos de confianza (IC) del 95% para la preeclampsia, la diabetes gestacional, el peso bajo al nacer y el parto prematuro fueron: 6,6% (IC de 95%: 4,9%, 8,6%), 8,5% (IC de 95%: 3,9%, 14,7%), 8,5% (IC de 95%: 7,2%, 9,8%) y 10,0% (IC de 95%: 8,0%, 12,0%), respectivamente. Se observó una heterogeneidad significativa en general, así como según el diseño del estudio. No se advirtieron grandes diferencias en las estimaciones según el nivel del sesgo. Conclusiones. Los resultados de este estudio ofrecen cálculos actualizados de algunos de los resultados adversos perinatales y del embarazo con mayor prevalencia en América Latina y el Caribe. Estos resultados ponen de manifiesto que existe una gran heterogeneidad en las estimaciones de prevalencia, que podría reflejar la diversidad de la población de la región. Objetivo. Estimar a prevalência pontual e os intervalos prováveis de hipertensão induzida pela gravidez, pré-eclâmpsia, diabetes gestacional, baixo peso ao nascer e parto prematuro na América Latina e no Caribe e avaliar a heterogeneidade das estimativas. Métodos. Realizou-se uma revisão sistemática com metanálise de estudos observacionais que relatam a prevalência de desfechos maternos e perinatais adversos em populações da América Latina e do Caribe, publicados entre 2000 e 2019 em inglês, espanhol ou português. Os bancos de dados PubMed, Embase e LILACS foram pesquisados. Estimou-se a prevalência pontual e avaliou-se a heterogeneidade geral, bem como, em análises de subgrupo, a heterogeneidade por delineamento do estudo e o nível de viés. Resultados. De 1 087 registros encontrados, 50 artigos foram incluídos na revisão: dois sobre distúrbios hipertensivos da gravidez, 14 sobre pré-eclâmpsia, seis sobre diabetes gestacional, nove sobre baixo peso ao nascer e 19 sobre parto prematuro. Não foi possível realizar metanálise para distúrbios hipertensivos da gravidez devido ao pequeno número de estudos. As estimativas de prevalência pontual e intervalos de confiança de 95% (IC) para pré-eclâmpsia, diabetes gestacional, baixo peso ao nascer e parto prematuro foram: 6,6%; (IC 95%: 4,9–8,6%), 8,5% (IC 95%: 3,9–14,7%), 8,5% (IC 95%: 7,2–9,8%) e 10,0% (IC 95%: 8,0– 12,0%), respectivamente. Observou-se heterogeneidade considerável, tanto em geral como por delineamento de estudo. Não foram observadas diferenças importantes nas estimativas por nível de viés. Conclusões. Os resultados deste estudo fornecem estimativas atualizadas de alguns dos desfechos gestacionais e perinatais adversos mais prevalentes na América Latina e no Caribe. Destacam a existência de uma importante heterogeneidade nas estimativas de prevalência, o que pode refletir a diversidade das populações da região.

ilustraciones, gráficas, tablas Objective: To estimate the security and effectivity of the reduction or retirement of antihypertensive medication in pregnant women with chronic hypertension. Methods: Randomized controlled trials that compared management with antihypertensive drugs vs. no antihypertensive, discontinuation of the drug, placebo, or other interventions were included. We searched CENTRAL, MEDLINE, LILACS, and ClinicalTrials. We also hand-searched conference proceedings (ACOG, FIGO, RCOG, FECOLSOG) and reference lists of retrieved studies. Two review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We resolved disagreements through consensus. We used the GRADE approach to assess the quality of evidence. Results: The search did not find any controlled clinical trial evaluating the reduction or withdrawal of antihypertensive therapy. When antihypertensive management was compared with placebo or no antihypertensive, we found that antihypertensive treatment was associated with reduction of probability of developing severe hypertension in pregnant women with chronic hypertension (OR 0,43 95% CI 0.26 to 0.70 ) and increased probability of adverse effects associated to antihypertensive management (aOR 8.52; 95% CI 1.05 to 69). We did not found differences in the probability of developing superimposed pre-eclampsia, preterm birth, placental abruption, small for gestational age, pregnancy loss, neonatal death, admission to the neonatal intensive care unit or low APGAR at birth. We did not found differences in gestational age at birth. Quality of the evidence was very low due to the presence of serious risk of bias, limitations in the applicability of results and the confidence interval. Conclusion: Very low-quality evidence suggest that probably antihypertensive therapy reduces the incidence of severe hypertension in pregnant women with chronic hypertension when compared with placebo or no antihypertensive. Objetivo: Estimar la seguridad y efectividad de la reducción o retiro de la medicación antihipertensiva en mujeres embarazadas con hipertensión crónica. Métodos: Se incluyeron ensayos controlados aleatorios que compararon el tratamiento con fármacos antihipertensivos versus ningún antihipertensivo, suspensión del fármaco, placebo u otras intervenciones. Se realizaron búsquedas en CENTRAL, MEDLINE, LILACS y ClinicalTrials. También se realizaron búsquedas manuales en las actas de congresos (ACOG, FIGO, RCOG, FECOLSOG). Dos autores de la revisión evaluaron de forma independiente los ensayos para su inclusión, extrajeron los datos y evaluaron el riesgo de sesgo. Los desacuerdos fueron resultos por consenso. Utilizamos el enfoque GRADE para evaluar la calidad de la evidencia. Resultados: La búsqueda no encontró ningún ensayo clínico controlado que evaluara la reducción o el retiro de la terapia antihipertensiva. Cuando se comparó el tratamiento antihipertensivo con placebo o ningún antihipertensivo, encontramos que el tratamiento antihipertensivo se asoció con una reducción de la probabilidad de desarrollar hipertensión grave en mujeres embarazadas con hipertensión crónica (OR 0,43; IC del 95%: 0,26 a 0,70) y una mayor probabilidad de efectos adversos. asociado al tratamiento antihipertensivo (ORa 8,52; IC del 95%: 1,05 a 69). No encontramos diferencias en la probabilidad de desarrollar preeclampsia superpuesta, parto prematuro, desprendimiento de placenta, pequeño para la edad gestacional, pérdida del embarazo, muerte neonatal, ingreso en la unidad de cuidados intensivos neonatales o APGAR bajo al nacer. No encontramos diferencias en la edad gestacional al nacer. La calidad de la evidencia fue muy baja debido a la presencia de un riesgo grave de sesgo, las limitaciones en la aplicabilidad de los resultados y el intervalo de confianza. Conclusión: La evidencia de muy baja calidad sugiere que probablemente la terapia antihipertensiva reduce la incidencia de hipertensión severa en mujeres embarazadas con hipertensión crónica en comparación con placebo o ningún antihipertensivo. (Texto tomado de la fuente). Texto en inglés Revisión sistemática con meta-análisis Especialidades Médicas Especialista en Obstetricia y Ginecología Methods Criteria for including studies in this review Randomized controlled trials or non-randomized controlled trials, published, unpublished and ongoing. Types of participants Pregnant women with a diagnosis of chronic hypertensive vascular disease defined as: systolic blood pressure greater than 130 mm Hg or diastolic pressure greater than 80 mm Hg (2,3) on at least two occasions 4 hours apart, before pregnancy or before 20 weeks of pregnancy (4). Type of intervention Withdrawal of antihypertensive drugs defined as abrupt suspension of drug use, de-staging of the drug until the withdrawal is complete, or decrease in current drug dose (16); versus: 1. Continue usual antihypertensive therapy with one or more medications of the type: alpha 2 agonists, calcium antagonists, alpha and beta blockers, alpha adrenergic antagonists, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, vasodilators, and diuretics. 2. Placebo. 3. Other interventions. Types of outcomes Primary Outcomes Maternal: Maternal death: Defined as the death of a woman due to direct or indirect obstetric causes during pregnancy or up to 42 days after its termination, regardless of the place in which it occurred or its duration (31). Severe preeclampsia: Defined as finding after week 20 of gestation up to 6 weeks postpartum of systolic blood pressure values greater than or equal to 160 mm Hg or diastolic blood pressure values greater than or equal to 110 mm Hg on two occasions separated by a short interval of time (5-15 minutes), or the finding of systolic blood pressure values greater than or equal to 140 mm Hg or diastolic blood pressure greater than or equal to 90 mm Hg on at least two occasions separated by four hours and associated with: thrombocytopenia (platelet count less than 100 x 109 / L); impaired liver function indicated by abnormal serum levels of liver enzymes (twice the higher level of reference); persistent severe pain in epigastrium or right upper quadrant not due to other diagnoses; renal failure (serum creatinine greater than 1.1 mg / dL or twice the baseline serum creatinine concentration in the absence of other kidney disease); pulmonary edema; recent-onset headache that does not respond to analgesic management and is not related to alternative diagnoses; hyperreflexia; visual disturbances such as photophobia, blurred vision, photopsia, scotomas, or blindness that are not related to alternative diagnoses (32); eclampsia defined as the sudden onset of focal or multifocal tonic-clonic seizures in the absence of other conditions that cause it such as epilepsy, cerebral ischemia or infarction, intracranial hemorrhage or use of medications; or HELLP syndrome defined as elevated lactic acid dehydrogenase (LDH) greater than or equal to 600 IU / L, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) greater than twice the upper limit of normality and platelets less than 100 x 109 / L (4). Admission to the Intensive Care Unit: defined as the requirement for care in intermediate or intensive care units (33). Adverse reactions: defined as adverse events caused by the withdrawal or use of antihypertensive medications, including palpitations, headache, joint pain, lower limb edema, orthostatic hypotension or rebound hypertension, in addition to changes in serum biochemistry, heart rate, pulse rate, kidney function, and left ventricular parameters (34). Fetal: Loss of pregnancy: Defined as abortion (death of the fruit of conception before week 20 or less than 500 g) or death (death of a fetus in utero after week 20 and greater than 500 g) (26). Neonatal Mortality: defined as those newborns who die before reaching 28 days of life (35). APGAR less than or equal to 5 at minute 5: defined by the Apgar scale that assesses the viability of a newborn according to five simple physio-anatomical parameters: muscle tone, respiratory effort, heart rate, reflexes and skin color, each parameter is assigned a score between 0 and 2 (36). Neonatal intensive care unit admission: defined as admission of a neonate to a neonatal intensive care unit for some neonatal condition that requires surveillance or monitoring (37). Among the causes of admission are: prematurity or birth weight less than 1500 g, gestational age less than 32 weeks, respiratory distress that requires ventilatory support (continuous positive pressure in the airway, mechanical ventilation), seizure syndrome; congenital abnormalities or inborn errors of metabolism, congenital heart disease or cardiac arrhythmias requiring cardiac management, hypoxic-ischemic encephalopathy, other conditions requiring neonatological consultation (severe hyperbilirubinemia, severe intrauterine growth restriction, birth weight between 1000 g 2000 g and gestational age between 32 and 36 weeks (38). Secondary outcomes Maternal Severe arterial hypertension: Defined as the finding of systolic blood pressure values greater than or equal to 160 mm Hg or diastolic blood pressure greater than or equal to 110 mm Hg on two occasions separated by a short time interval (minutes) (4). Gestational age at delivery: Defined as weeks from conception to the date of delivery. It will be calculated taking into account the gestational age reported in the first trimester ultrasound (up to week 13 6/7) or that of the subsequent trimesters if the first trimester is not provided. If the date of the last menstruation agrees with the gestational age obtained through the ultrasound of the first trimester or of the subsequent trimesters, it can be used (39). Hospitalization During Pregnancy: Defined as admission to a hospital during pregnancy (40) Renal compromise: Defined as serum creatinine greater than or equal to 1.1 mg / dL (4). Placental abruption: Defined as a process consisting of premature detachment of the placenta characterized by vaginal bleeding, uterine hypertonicity or unsatisfactory fetal status associated with direct visualization of retroplacental hemorrhage or hematoma (41). Fetal: Small for gestational age fetus: defined as a newborn whose weight is less than the 10th percentile for gestational age (42). Preterm delivery: Defined as delivery before 37 weeks of gestation (43). Hypoxic / Ischemic Encephalopathy: defined as the presence of neurological dysfunction in the form of neonatal encephalopathy, associated with depression of the level of consciousness, respiratory depression, alteration of muscle tone and seizures, associated with suggestive findings on brain MRI (44). Search methods for identification of studies Electronic searches A comprehensive search was conducted to identify as many relevant studies as possible in the electronic databases. A combination of controlled vocabulary was used (MeSH, Emtree terms, Health Sciences, and descriptors (DeCS). The following electronic databases were searched: - Cochrane Central Register of Controlled Trials (CENTRAL). - MEDLINE, PubMed - EMBASE Ovid - LILACS (Health Sciences of Latin America and the Caribbean). Search for other resources The following resources were sought for additional studies: • International Clinical Trials Registry Platform (ICTRP) https://apps.who.int/trialsearch/AdvSearch.aspx • Gray literature: a search was carried out in the information system for gray literature in Europe “OpenGrey”. Manual search Abstracts of the following conferences were hand searched: - International Federation of Gynecology and Obstetrics (FIGO) (www.figo.org). - American College of Obstetricians and Gynecologists (ACOG) (www.acog.org). - Royal College of Obstetricians and Gynecologists (RCOG) (www.rcog.org.uk). - Colombian Federation of Obstetrics and Gynecology. (https://www.fecolsog.org/) Data extraction and analysis The following methods were used when the reports were identified: Study selection Two reviewers independently assessed the inclusion of all potential studies that were identified as a result of the search strategy. Relevance and adherence to the inclusion criteria were evaluated. If studies did not meet the inclusion criteria, they were not included and the reasons for exclusion were wrote. Any disagreement was resolved through discussion or, if necessary, a third reviewer was consulted. Data extraction and management A form for data extraction was designed. For chosen studies, two reviewers extracted data using the agreed form. Discrepancies were resolved through discussion or, if necessary, a third reviewer was consulted. The data was entered into the RevMan 2019 software and verified for accuracy. When the information on any of the previous points was not clear, an attempt was made to contact the authors and editors of the original studies and the journals where they were published to provide more details. Assessment of risk of bias in included studies The risk of bias from randomized clinical trials was assessed using the criteria described in RoB 2.0 bias assessment tool (45). Any disagreement was resolved by discussion or involving a third reviewer. RoB 2.0 risk assessment of biases Assessment of the quality of evidence using the GRADE system The quality of evidence was evaluated using the GRADE system as specified in the GRADE manual so as to assess the quality of evidence related to the outcomes of the main comparison. Antihypertensive withdrawal was defined as abrupt discontinuation of drug use, de-escalation of the drug until complete withdrawal or tapering of the drug dose compared to continuing established antihypertensive therapy, Placebo and Other interventions. A summary of the effect of the intervention and of the quality measurement for each of the next outcomes was developed using the GRADE system (Annexed tables 1 and 2). Measurement of treatment effect Dichotomous data The results were reported as a probability ratio (OR) with a 95% confidence interval (CI). Continuous data The mean difference (MD) was used if the results are measured in the same way within the included studies and the standardized mean difference (SMD) was used to combine trials measuring the same outcome, but with different methods. Assessment of missing data An intention-to-treat analysis was performed, that is, an attempt was made to include all participants assigned to each analysis group and all participants who were analyzed in the group to which they were assigned, regardless of whether or not they received the assigned intervention. The impact of including studies with high levels of missing data in the overall evaluation of treatment effects was explored using a sensitivity analysis. Assessment of heterogeneity Statistical heterogeneity was assessed using I2 values and Chi square test values. Heterogeneity was considered substantial if the I2 statistical value was greater than 40% or if there was a low p-value (less than 0.10) in the Chi-square test. Assessment of reporting bias Publication bias was assessed when ten or more studies were retrieved through the evaluation of the asymmetry of the funnel plot and the formal tests. For continuous variables, the test proposed by Egger was used (46), and for dichotomous results the test proposed by Harbord was used (47). Subgroup analysis and investigation of heterogeneity We explored the following potential sources of heterogeneity where it was considered that the effect size may have changed based on their results using subgroup analysis. 1. Definition of chronic arterial hypertension. Chronic arterial hypertension defined as SBP greater than or equal to 130 and DBP greater than or equal to 80 vs. defined as SBP greater than or equal to 140 and DBP greater than or equal to 90. 2. Subgroup of type of antihypertensive. alpha 2 agonists, calcium antagonists, alpha blockers, beta blockers, alpha adrenergic antagonists, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, vasodilators, and diuretics. 3. Etiology of hypertension. Primary hypertension vs. secondary hypertension. Data analysis Statistical analysis was performed using RevMan 2019, a fixed-effect meta-analysis was used to pool the data when it was reasonable to assume that the studies estimated the same underlying treatment effect, that is, when the studies examined the same intervention, and the populations and study methods were sufficiently similar. When there was sufficient clinical heterogeneity to have expected underlying treatment effects differed between studies or substantial statistical heterogeneity, a random effects meta-analysis was performed. The average effect of the random effects was assessed as the average range of possible treatment effects and the clinical implications of treatment effects that differed between trials was discussed. If the average effect was not clinically significant, the trials were not combined. If random effects analysis was used, the results were presented as the mean treatment effect and 95% confidence intervals and I2 estimates. Sensitivity analysis A sensitivity analysis was performed by type of studies and based on other aspects of the review that may had have an effect on the results, a sensitivity analysis was also performed to explore the inclusion of the effects of fixed or random effects analysis for the results with statistical heterogeneity.