New hypertension ≥140/90 after 20 weeks gestation + proteinuria or end-organ dysfunction.
Risk factors
- • Nulliparity, age >40
- • Prior pre-eclampsia
- • Multiple pregnancy
- • CKD, HTN, DM, antiphospholipid
Clinical features
- • Headache
- • Visual disturbance
- • RUQ pain
- • Oedema, rapid weight gain
Examination
- • BP ≥140/90
- • Hyperreflexia, clonus
- • Papilloedema (rare)
Investigations
- • Urine PCR/ACR
- • FBC, LFT, U&E, urate
- • PlGF / sFlt-1 ratio
- • CTG, growth scan, dopplers
Diagnosis
- • BP + proteinuria OR end-organ dysfunction (renal, hepatic, neuro, haematological, uteroplacental)
Differential diagnosis
- • Chronic hypertension
- • Gestational HTN
- • HELLP
- • AFLP
Management
- • Labetalol / nifedipine for BP <135/85
- • IV labetalol / hydralazine for severe HTN
- • Magnesium sulfate for severe / eclampsia prophylaxis
- • Delivery is definitive — timing by severity & gestation
Drug therapy
- • Labetalol 200 mg PO bd–qds
- • Magnesium sulfate 4 g IV load + 1 g/h
- • Aspirin 150 mg from 12 wk in next pregnancy
Complications
- • Eclampsia
- • HELLP
- • Placental abruption
- • Stroke
- • FGR, stillbirth
Clinical pearls
- • BP target now 135/85 (CHIPS, CHAP)
Related in WardRound
Educational — verify locally.
