Table 1 National Institute for health and Care Excellence’s Hypertension in Pregnancy key priority recommendations [15]

Prevention

 Advise women at high risk of pre-eclampsia to take 75 mg of aspirin daily from 12 weeks until the birth of the baby. Women at high risk are those with any of the following

 • hypertensive disease during a previous pregnancy

 • chronic kidney disease

 • autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome

 • type 1 or type 2 diabetes

 • chronic hypertension.

Surveillance

 Use an automated reagent-strip reading device or a spot urinary protein:creatinine ratio for estimating proteinuria in a secondary care setting (women with hypertension)

Treatment

 Tell women who take angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs):

 • that there is an increased risk of congenital abnormalities if these drugs are taken during pregnancy

 • to discuss other antihypertensive treatment with the healthcare professional responsible for managing their hypertension, if they are planning pregnancy.

 In pregnant women with uncomplicated chronic hypertension aim to keep blood pressure lower than 150/100 mmHg.

 Offer women with gestational hypertension and pre-eclampsia an integrated package of care covering admission to hospital, treatment, measurement of blood pressure, testing for proteinuria and blood tests as indicated

Documentation

 Consultant obstetric staff should document in the woman’s notes the maternal (biochemical, haematological and clinical) and fetal thresholds for elective birth before 34 weeks in women with pre-eclampsia.

Review

 Offer all women who have had pre-eclampsia a medical review at the postnatal review (6–8 weeks after the birth)

 Tell women who had pre-eclampsia their risk of developing a hypertensive disorder of pregnancy in the future