Gestational hypertension

Question 1

Mild hypertension (140/90 to 149/99 mmHg)

Answer 1

• Admit to hospital: No
• Treat: No
• Measure BP: Not more than once a week
• Test for proteinuria: At each visit
• Bloods: Only those for routine ANC
• Presenting before 32 weeks, or at high risk of pre-eclampsia, measure blood pressure and test urine twice weekly

Question 2

Moderate hypertension (150/100 to 159/109 mmHg)

Answer 2

• Admit to hospital: No
• Treat: With oral labetalol as first-line treatment to keep:
  diastolic blood pressure between 80–100 mmHg
  systolic blood pressure less than 150 mmHg
• Measure BP: At least twice a week
• Test for proteinuria: At each visit
• Bloods: Test kidney function, electrolytes, full blood count, transaminases, bilirubin
  Do not carry out further blood tests if no proteinuria at subsequent visits

Question 3

Severe hypertension (160/110 mmHg or higher)

Answer 3

• Admit to hospital: Yes (until blood pressure is 159/109 mmHg or lower)
• Treat:With oral labetalol as first-line treatment to keep:
  diastolic blood pressure between 80–100 mmHg
  systolic blood pressure less than 150 mmHg
• Measure BP: At least four times a day
• Test for proteinuria: Daily
• Bloods: Test at presentation and then monitor weekly:

Question 4

Timing of delivery in gestational hypertension

Answer 4

If BP controlled, decision to deliver depends on consultant

Question 5

Postnatal care of gestational hypertension

Answer 5

• Daily BP 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
• Continue use of antenatal antihypertensive treatment
• Consider reducing antihypertensive treatment if their blood pressure falls below 140/90 mmHg
• Reduce antihypertensive treatment if their blood pressure falls below 130/80 mmHg
• If still on antihypertensives 2/52 postnatal, offer medical review; if still on tx after 6-8/52 refer to specialist