Defined by blood pressure (BP) ≥140/90 mmHg on two occasions (at least 4 hours apart) during pregnancy after 20 weeks' gestation in a previously normotensive patient, without the presence of proteinuria or other clinical features suggestive of pre-eclampsia (thrombocytopenia, impaired renal or kidney function, pulmonary oedema, or new-onset headache).
Patient is usually asymptomatic.
Patient requires regular monitoring of BP and urinalysis during the pregnancy to exclude pre-eclampsia and gestational diabetes.
Mild hypertension is managed with lifestyle modification and antihypertensive therapy.
Severe hypertension (BP ≥160/110 mmHg) requires admission for antihypertensive therapy.
For women ≥37 weeks' gestation, induction should be considered.
Gestational hypertension is defined by BP readings of ≥140/90 mmHg on two occasions at least 4 hours apart during pregnancy after 20 weeks’ gestation in a previously normotensive patient, without the presence of proteinuria (<300 mg in 24 hours) or other clinical features suggestive of of pre-eclampsia (thrombocytopenia, impaired renal or kidney function, pulmonary oedema, or new-onset headache).
History and exam
Key diagnostic factors
- presence of risk factors
- previously normotensive
- BP ≥140/90 mmHg
Other diagnostic factors
- >20 weeks' gestation
- absence of symptoms that suggest pre-eclampsia
- black or Hispanic ethnicity
- mother being small for gestational age
- type 1 diabetes mellitus
1st investigations to order
- electrolytes, urea, creatinine
- uric acid
Investigations to consider
- 24-hour BP monitoring
- fetal ultrasound
- proteinuria (spot testing, 24-hour urine collection)
<37 weeks' gestation
≥37 weeks' gestation
- Hypertension, essential
- Gestational hypertension and preeclampsia
- Perinatal forms guideline: a guide for completion of the British Columbia maternal and fetal levels of service classification tool (PSBC 1589)
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