- in women with gestational hypertension, take account of the following risk factors that require additional assessment and follow-up:
- nulliparity
- age 40 years or older
- pregnancy interval of more than 10 years
- family history of pre-eclampsia
- multiple pregnancy
- BMI of 35 kg/m2 or more
- gestational age at presentation
- previous history of pre-eclampsia or gestational hypertension
- pre-existing vascular disease
- pre-existing kidney disease
A summary of management of gestational hypertension guidance (1) is presented below:
Management of pregnancy with gestational hypertension
Classification of Hypertension | Hypertension: blood pressure of 140/90- 159/ 109mmHg | Severe hypertension: blood pressure of 160/110mmHg or more |
| Do not routinely admit to hospital | Admit, but if BP falls below 160/ 110 mmHg then manage as for hypertension |
Antihypertensive pharmacological treatment | Offer pharmacological treatment if BP remains above 140/90 mmHg | Offer pharmacological treatment to all women |
Target blood pressure once on antihypertensive treatment | Aim for BP of 135/85 mmHg or less | Aim for BP of 135/85 mmHg or less |
Blood Pressure Measurement | Once or twice a week (depending on BP) until BP is 135/85 mmHg or less | Every 15-30 minutes until BP is less than 160/110 mmHg |
Dipstick proteinuria testing (a) | Once or twice a week (with BP measurement) | |
| Measure full blood count, liver function and renal function at presentation and then weekly | Measure full blood count, liver function and renal function at presentation and then weekly |
| Carry out PlGF-based testing on 1 occasion if there is suspicion of preeclampsia | Carry out PlGF-based testing on 1 occasion if there is suspicion of preeclampsia |
| Offer fetal heart auscultation at every antenatal appointment Carry out ultrasound assessment of the fetus at diagnosis and, if normal, repeat every 2 to 4 weeks, if clinically indicated Carry out a CTG only if clinically indicated | Offer fetal heart auscultation at every antenatal appointment Carry out ultrasound assessment of the fetus at diagnosis and, if normal, repeat every 2 weeks, if severe hypertension persists Carry out a CTG at diagnosis and then only if clinically indicated |
(a) Use an automated reagent-strip reading device for dipstick screening for proteinuria in a secondary care setting.
Abbreviations: BP, blood pressure; CTG, cardiotography
Notes:
- ofer placental growth factor (PlGF)-based testing to help rule out preeclampsia in women presenting with suspected pre-eclampsia (for example, with gestational hypertension) between 20 weeks and up to 35 weeks of pregnancy
- do not offer bed rest in hospital as a treatment for gestational hypertension
- Timing of birth
- do not offer planned early birth before 37 weeks to women with gestational hypertension whose blood pressure is lower than 160/110 mmHg, unless there are other medical indications
- for women with gestational hypertension whose blood pressure is lower than 160/110 mmHg after 37 weeks, timing of birth, and maternal and fetal indications for birth should be agreed between the woman and the senior obstetrician.
- if planned early birth is necessary, offer a course of antenatal corticosteroids and magnesium sulfate if indicated
- Postnatal investigation, monitoring and treatment
- in women with gestational hypertension who have given birth, measure blood pressure:
- daily for the first 2 days after birth
- at least once between day 3 and day 5 after birth
- as clinically indicated if antihypertensive treatment is changed after birth
- in women with gestational hypertension who have given birth:
- continue antihypertensive treatment if required
- advise women that the duration of their postnatal antihypertensive treatment will usually be similar to the duration of their antenatal treatment (but may be longer)
- reduce antihypertensive treatment if their blood pressure falls below 130/80 mmHg
- if a woman has taken methyldopa to treat gestational hypertension, stop within 2 days after the birth and change to an alternative treatment if necessary
- for women with gestational hypertension who did not take antihypertensive treatment and have given birth, start antihypertensive treatment if their blood pressure is 150/100mmHg or higher
- offer women who have had gestational hypertension and who remain on antihypertensive treatment, a medical review with their GP or specialist 2 weeks after transfer to community care
- offer all women who have had gestational hypertension a medical review with their GP or specialist 6-8 weeks after the birth
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