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Hypertension in pregnancy: diagnosis and management

Key priorities for implementation

Reducing the risk of hypertensive disorders in pregnancy

  • Advise women at high risk of pre-eclampsia to take 75 mg of aspirin* daily from 12 weeks until the birth of the baby. Women at high risk are those with any of the following:
    • hypertensive disease during a previous pregnancy
    • chronic kidney disease
    • autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome
    • type 1 or type 2 diabetes
    • chronic hypertension

Management of pregnancy with chronic hypertension

  • Tell women who take angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs):
    • that there is an increased risk of congenital abnormalities if these drugs are taken during pregnancy
    • to discuss other antihypertensive treatment with the healthcare professional responsible for managing their hypertension, if they are planning pregnancy
  • In pregnant women with uncomplicated chronic hypertension aim to keep blood pressure lower than 150/100 mmHg

Assessment of proteinuria in hypertensive disorders of pregnancy

  • Use an automated reagent-strip reading device or a spot urinary protein:creatinine ratio for estimating proteinuria in a secondary care setting

Management of pregnancy with gestational hypertension

  • Offer women with gestational hypertension an integrated package of care covering admission to hospital, treatment, measurement of blood pressure, testing for proteinuria and blood tests

Management of pregnancy with pre-eclampsia

  • Offer women with pre-eclampsia an integrated package of care covering admission to hospital, treatment, measurement of blood pressure, testing for proteinuria and blood tests
  • Consultant obstetric staff should document in the woman’s notes the maternal (biochemical, haematological and clinical) and fetal thresholds for elective birth before 34 weeks in women with pre-eclampsia
  • Offer all women who have had pre-eclampsia a medical review at the postnatal review (6–8 weeks after the birth)

Advice and follow-up care at transfer to community care

  • Tell women who had pre-eclampsia that their risk of developing:
    • gestational hypertension in a future pregnancy ranges from about
      1 in 8 (13%) pregnancies to about 1 in 2 (53%) pregnancies
    • pre-eclampsia in a future pregnancy is up to about 1 in 6 (16%) pregnancies
    • pre-eclampsia in a future pregnancy is about 1 in 4 (25%) pregnancies if their pre-eclampsia was complicated by severe pre-eclampsia, haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome or eclampsia and led to birth before 34 weeks, and about 1 in 2 (55%) pregnancies if it led to birth before 28 weeks

* Unlicensed indication–obtain and document informed consent

full guideline available from…
National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT
www.nice.org.uk/guidance/CG107

National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. August 2010
First included: October 2010.