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Management principles - when to treat, admit to hospital and further tests and monitoring

Last edited 10 Aug 2019

Treatment guidance for preeclampsia has been outlined (1) and is summarised below:

Management of Hypertension in Pre-eclampsia

	Degree of Hypertension - blood pressure of 140/90-159/ 109mmHg	Degree of Hypertension - Severe hypertension: blood pressure of 160/ 110mmHg or more
Admission to Hospital	Admit if any clinical concerns for the wellbeing of the woman or baby or if high risk of adverse events suggested by the fullPIERS or PREP-S risk prediction models	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	At least every 48 hours, and more frequently if the woman is admitted to hospital	Every 15-30 minutes until BP is less than 160/110 mmHg, then at least 4 times daily while the woman is an inpatient, depending on clinical circumstances
Dipstick proteinuria testing (a)	Only repeat if clinically indicated, for example, if new symptoms and signs develop or if there is uncertainty over diagnosis	Only repeat if clinically indicated, for example, if new symptoms and signs develop or if there is uncertainty over diagnosis
Blood tests	Measure full blood count, liver function and renal function twice a week	Measure full blood count, liver function and renal function 3 times a week
Fetal Assessment	Offer fetal heart auscultation at every antenatal appointment Carry out ultrasound assessment of the fetus at diagnosis and, if normal, repeat every 2 weeks Carry out a CTG at diagnosis and then only if clinically indicated (See section 1.6 for advice on fetal monitoring	Offer fetal heart auscultation at every antenatal appointment Carry out ultrasound assessment of the fetus at diagnosis and, if normal, repeat every 2 weeks Carry out a CTG at diagnosis and then only if clinically indicated (See section 1.6 for advice on fetal monitoring)

(a) Use an automated reagent-strip reading device for dipstick screening for proteinuria in a secondary care setting. Abbreviations: BP, blood pressure; CTG, cardiotocography.

Notes:

offer labetalol to treat hypertension in pregnant women with pre-eclampsia
only offer women with pre-eclampsia antihypertensive treatment other than labetalol after considering side-effect profiles for the woman, fetus and newborn baby
- offer nifedipine for women in whom labetalol is not suitable, and methyldopa if labetalol or nifedipine are not suitable
  - base the choice on any pre-existing treatment, side-effect profiles, risks (including fetal effects) and the woman's preference

Reference:

1) NICE (August 2010). Hypertension in pregnancy - the management of hypertensive disorders during pregnancy

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