| Table 1: Recommended criteria for deciding when to admit women with hypertension in pregnancy to hospital and when to start antihypertensive therapy* |
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Admission to hospital (grade D)
Mandatory
- SBP > 169 mm Hg or DBP > 109 mm Hg or presenting with symptoms (epigastric pain, visual disturbance or severe headache)
Strongly recommended
- Gestational hypertension with proteinuria, unless special outpatient care program is available
- Pre-existing hypertension with superimposed gestational hypertension
- Gestational, pre-existing or unclassified hypertension without proteinuria in women with DBP > 99 mm Hg
- Pre-existing hypertension necessitating antihypertensive drug treatment and for which outpatient surveillance is impossible
Recommended
- Gestational hypertension without proteinuria or unclassified hypertension with DBP 90-99 mm Hg in order to:
- Obtain serial blood pressure readings
- Exclude conditions associated with poor outcome
- Assess fetal well-being
Transfer to tertiary care facility should be considered according to locally available neonatal care |
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Initiation of antihypertensive drug treatment
Immediately
- SBP > 169 mm Hg or DBP > 109 mm Hg with symptoms (grade D)
After 1-2 hours of observation
- SBP > 169 mm Hg or DBP > 109 mm Hg without symptoms (grade D)
After 24-48 hours of observation
- SBP > 139 mm Hg or DBP > 89 mm Hg before 28 weeks' gestation in women with gestational hypertension without proteinuria (grade D) or in those with pre-existing hypertension (grade A)9
- SBP > 139 mm Hg or DBP > 89 mm Hg any time in pregnancy in women with
- gestational hypertension with symptoms (grade D),
- gestational hypertension with proteinuria, (grade D)
- pre-existing hypertension with underlying conditions (grade D),
- pre-existing hypertension with target-organ damage (cardiovascular disease, renal impairment) (grade D), or
- pre-existing hypertension with superimposed gestational hypertension (grade D)
- SBP > 149 mm Hg or DBP > 94 mm Hg in other circumstances (grade D)
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*These recommendations do not apply to women in labour. See Appendix 1 for definitions of the grades of recommendations. SBP = systolic blood pressure, DBP = diastolic blood pressure. |
