It's useful to remember that in normal pregnancy:
NICE published guidance in 2010 on the management of hypertension in pregnancy. They also made recommendations on reducing the risk of hypertensive disorders developing in the first place. Women who are at high risk of developing pre-eclampsia should take aspirin 75mg od from 12 weeks until the birth of the baby.
Hypertension in pregnancy in usually defined as:
After establishing that the patient is hypertensive they should be categorised into one of the following groups
| Pre-existing hypertension | Pregnancy-induced hypertension(PIH, also known as gestational hypertension) | Pre-eclampsia |
|---|---|---|
| A history of hypertension before pregnancy or an elevated blood pressure > 140/90 mmHg before 20 weeks gestation |
No proteinuria, no oedema
Occurs in 3-5% of pregnancies and is more common in older women
If a pregnant woman takes an ACE inhibitor or angiotensin II receptor blocker (ARB) for pre-existing hypertension this should be stopped immediately and alternative antihypertensives started (e.g. labetalol) whilst awaiting specialist review | Hypertension (as defined above) occurring in the second half of pregnancy (i.e. after 20 weeks)
No proteinuria, no oedema
Occurs in around 5-7% of pregnancies
Resolves following birth (typically after one month). Women with PIH are at increased risk of future pre-eclampsia or hypertension later in life | Pregnancy-induced hypertension in association with proteinuria (> 0.3g / 24 hours)
Oedema may occur but is now less commonly used as a criteria
Occurs in around 5% of pregnancies |
Management