Gestational Hypertension Management

Delivery Criteria

Women with gestational hypertension should be delivered at 37 weeks and 0 days gestation, or earlier if they develop severe hypertension requiring three antihypertensive classes, progressive thrombocytopenia, worsening liver or kidney function, pulmonary edema, severe neurological symptoms, or nonreassuring fetal status, as recommended by the American College of Cardiology 1
Routine delivery is recommended at 37 weeks and 0 days gestation for all women with gestational hypertension, regardless of severity, according to the European Society of Cardiology 1, 2

Initiate antihypertensive therapy when blood pressure consistently reaches ≥140/90 mmHg in clinic (or ≥135/85 mmHg at home), with a target diastolic blood pressure of 85 mmHg and systolic blood pressure of 110-140 mmHg, as recommended by the American Heart Association 1
Blood pressure ≥160/110 mmHg requires urgent treatment in a monitored setting, with first-line agents including oral nifedipine (immediate-release) or intravenous labetalol or hydralazine, according to the European Society of Cardiology 1

Blood pressure monitoring at every visit, with repeated assessments for new-onset proteinuria if not already present, and laboratory tests at minimum twice weekly, including complete blood count, liver function tests, and renal function tests, as recommended by the American College of Obstetricians and Gynecologists 1
Initial assessment to confirm fetal well-being upon diagnosis, with serial fetal surveillance with ultrasound if fetal growth restriction is present, and continuous electronic fetal heart rate monitoring when delivery is being considered, according to the European Society of Cardiology 1

Women with gestational hypertension should be assessed in hospital when first diagnosed, and all women with severe features require hospitalization in centers with adequate maternal and neonatal intensive care resources, as recommended by the European Society of Cardiology 1, 2
Magnesium sulfate should be administered for seizure prophylaxis in women with gestational hypertension who have proteinuria AND severe hypertension (≥160/110 mmHg), or any neurological signs or symptoms, according to the American College of Obstetricians and Gynecologists 1, 4