Management of PET

Question 1

Mild Hypertension

140/90 to 149/99

Answer 1

• Admit to hospital: yes
• Treat: No
• Measure BP: 4 times a day
• Test for proteinuria: Do not repeat quantification of proteinuria
• Bloods: twice a week

Question 2

Moderate hypertension

150/100 to 159/109

Answer 2

• Admit to hospital: yes
• 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: 4 times a day
• Test for proteinuria: Do not repeat quantification of proteinuria
• Bloods: three times a week

Question 3

Severe hypertension

160/110 or more

Answer 3

• Admit to hospital: yes
• 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: More than 4 times a day dep on circumstances
• Test for proteinuria: Do not repeat quantification of proteinuria
• Bloods: three times a week

Question 4

Timing of birth in PET

Answer 4

• Tx conservatively until 34 weeks if possible
• No “same day delivery” plan
• Recommend birth for women who have pre-eclampsia with severe hypertension after 34 weeks when their blood pressure has been controlled
• Offer birth to women who have pre-eclampsia with mild or moderate hypertension at 34+0 to 36+6 weeks depending on maternal and fetal condition, risk factors and availability of neonatal intensive care
• Recommend birth within 24–48 hours for women who have pre-eclampsia with mild or moderate hypertension after 37+0 weeks

Question 5

Postnatal care of women with PET

Answer 5

• If on tx at least four times a day while the woman is an inpatient +
• every 1–2 days for up to 2 weeks after transfer to community care until the woman is off treatment and has no hypertension
• If no tx at least four times a day while the woman is an inpatient +
• At least once between day 3 and day 5 after birth
  on alternate days until normal, if blood pressure was abnormal on days 3–5
• Continue 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.

Question 6

Haematological and biochemical monitoring postnatally

Answer 6

• Measure platelet count, transaminases and serum creatinine 48–72 hours after birth or step-down
• Do not repeat if results are normal at 48–72 hours
• Consider repeating bloods and urine at the 6/52 f/up
• If still proteinuria, repeat at 3/12 and potentially refer