Management of Hypertension in Pregnancy

Diagnosis and Assessment

The American College of Obstetricians and Gynecologists recommends that patients with severe hypertension (BP 160/100 mmHg) at term without documented proteinuria or laboratory evaluation require immediate comprehensive evaluation for preeclampsia with urgent laboratory testing and urine protein assessment, followed by blood pressure control and consideration of augmentation of labor with amniotomy and oxytocin 1, 2
Blood pressure ≥160/100 mmHg mandates same-day hospital assessment and urgent treatment in a monitored setting, according to the British Medical Journal 3, 2
Immediate laboratory testing must include complete blood count, liver enzymes, serum creatinine and uric acid, and urinalysis with protein:creatinine ratio or 24-hour urine collection, as recommended by the American Heart Association 1, 2

The American Heart Association recommends that BP ≥160/110 mmHg requires urgent treatment regardless of proteinuria status to prevent maternal stroke and other complications, with first-line agents including oral nifedipine, IV labetalol, and IV hydralazine 2, 5
Target blood pressure should be diastolic 85 mmHg and systolic <160 mmHg, according to the American College of Cardiology 2, 4
Antihypertensive drugs should be reduced or ceased if diastolic BP falls <80 mmHg to avoid compromising uteroplacental perfusion, as recommended by the American Heart Association 2, 4

The American College of Obstetricians and Gynecologists recommends augmentation of labor with amniotomy and oxytocin for patients with slow cervical progress at term gestation, according to the American College of Obstetricians and Gynecologists 2, 5
Women with gestational hypertension or preeclampsia at ≥37 weeks should be delivered rather than managed expectantly, with the optimum delivery time for gestational hypertension without preeclampsia features being 38-39 weeks, as recommended by the American College of Obstetricians and Gynecologists 2

Continuous cardiotocography (CTG) is mandatory for patients with maternal hypertension, and should be monitored for signs of fetal compromise that would necessitate expedited delivery, according to the American College of Obstetricians and Gynecologists 2
Proceed immediately to cesarean delivery if there is inability to control BP, progressive thrombocytopenia, deteriorating liver/renal function, ongoing severe neurological features, placental abruption, or non-reassuring fetal status on CTG, as recommended by the American College of Obstetricians and Gynecologists 2, 3, 5