Gestational Hypertension
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Admit severe hypertension; assess for pre-eclampsia when symptoms, proteinuria, laboratory abnormalities or fetal concerns develop.
When clinic, day care or home care may be suitable
- Non-severe gestational hypertension does not require automatic admission when investigations, fetal wellbeing and reliable follow-up are reassuring.
Before going home
- No severe BP or evolving pre-eclampsia; a stable oral regimen and a feasible maternal/fetal follow-up plan are documented.
- After birth, complete symptom/BP assessment and communicate the plan for the expected postpartum BP rise.
Discharge medicines and treatment changes
- Continue indicated antihypertensive treatment; stop methyldopa within 2 days of birth. Record the prescriber and thresholds for reducing/stopping treatment rather than advising the patient to stop on their own.
Medicine doses — use only when indicated
Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.
Use only if this is the selected discharge antihypertensive.
- Indication: Maintenance hypertension during pregnancy/postpartum
- BP/heart rate, postural symptoms; neonatal glucose/heart-rate observation after late-pregnancy exposure
Alternative maintenance option; do not substitute the acute immediate-release sequence.
- Indication: Maintenance hypertension in pregnancy/postpartum
- BP, headache, flushing, oedema and pulse
Tests, pending results and their reviewer
- Record the urine protein and blood-test assessment used to exclude pre-eclampsia; repeat sooner if the clinical state changes.
Home care and counselling
- Teach correct BP measurement if home monitoring is used and provide an urgent-contact number.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
After birth: first 2 days and day 3–5 | Check BP; prescribe additional checks for abnormal readings. |
2 weeks if on medication; 6–8 weeks for all | Review treatment and whether hypertension has resolved; persistent hypertension needs ongoing primary/specialist care. |
Return urgently
- Headache, visual symptoms, upper abdominal pain, breathlessness, seizures or severe BP need immediate assessment, including after delivery.
Open the complete discharge checklist →
Treatment
① Immediate stabilization — first minutes
- Severe-range BP → treat as emergency (emergency-severe-htn)
- Non-severe: outpatient pathway with strict escalation rules
③ First-line treatment & drug regimens
NICE NG133 offers medication when BP remains above 140/90 mmHg, with target 135/85 mmHg or less during treatment. It does not restrict treatment to severe-range BP. Choose an appropriate maintenance agent and monitor for progression to pre-eclampsia.
- Maintenance hypertension during pregnancy/postpartum
- BP/heart rate, postural symptoms; neonatal glucose/heart-rate observation after late-pregnancy exposure
- Maintenance hypertension in pregnancy/postpartum
- BP, headache, flushing, oedema and pulse
- Maintenance hypertension during pregnancy; not emergency BP rescue
- Postpartum stopping recommendation: NICE NG133.
- BP, sedation/mood; blood count and LFTs for fever, jaundice or suspected toxicity
Definitive treatment
For stable gestational hypertension with BP below 160/110, NICE advises no planned birth before 37 weeks without another indication; after 37 weeks agree timing with the woman and senior obstetrician. Earlier birth may be needed for severe hypertension, pre-eclampsia or fetal compromise.
Monitoring
| Setting | Schedule |
|---|---|
Outpatient (BP <160/110, normal labs, reassuring fetus) | Twice-weekly BP + weekly labs (platelets/LFT); growth scans q2–3 wks |
Any severe feature | Hospital admission — convert to severe pathway |
Response assessment
- Stable BP without progression to PE through 37 weeks → planned birth
Treatment failure
- Progression to proteinuria/lab abnormality → reclassify as pre-eclampsia (deliver timing per severity)
- Severe-range BP → emergency treatment + delivery decision
Escalation
- HDU if severe-range BP or evolving PE
- Tertiary transfer if <34 wks needing expectant management with NICU facilities
⑮ Complications & their management
Progression to pre-eclampsia (~25%)
Switch pathways; steroids if <34+6 at risk of birth
Abruptio placentae (small absolute risk)
See aph-abruption
Post-treatment care
- Postpartum BP checks (day 1–2, then clinic 1–2 weeks)
- If BP persists >42 days postpartum → new chronic hypertension workup
- Future CV risk counselling
Diagnosis & assessment
- Any new proteinuria or symptom cluster → now pre-eclampsia
- Severe-range BP
- Abnormal labs (platelets/LFT/creatinine)
- FGR or abnormal Doppler
Definition: BP ≥140/90 mmHg on two occasions ≥4 h apart after 20 weeks gestation in a previously normotensive woman, returning to normal by 42nd postpartum day, with NO features of pre-eclampsia (FOGSI GCPR 2026 §3.2 criteria framework).
Presentation
- Usually asymptomatic at routine ANC check
- Headache if BP high
Initial assessment
- Confirm BP twice ≥4h apart (or sooner if severe)
- Quantify protein (PrCr/ACR/24h) — mandatory to classify correctly
- CBC + platelets, LFTs, creatinine, urate
- Fetal growth assessment + umbilical artery Doppler if growth concern
Investigations
| Test | Looking for |
|---|---|
Protein quantification | Exclusion of pre-eclampsia |
Platelets + LFTs | Occult HELLP/pre-eclampsia |
Growth scan ± UA Doppler | Placental dysfunction |
Principles & follow-up
Management principles
Sources (11)
2026-01 · checked 2026-08-23 · verified-live
Open source ↗
PDF served from fogsi.org (2026 upload path) — definitions, HDP-Gestosis score, treatment threshold ≥140/90 (WOG), targets ≤140/90, delivery timing (GH term; mild PE 37 wks; severe PE after 34 wks; eclampsia deliver once stabilised post-MgSO4; ≤24 wks immediate delivery better; individualise 24–33+6…
2021 (publ 2022 Hypertension) · checked 2026-08-23 · verified-live
Open source ↗
Full PDF: standardised BP measurement; proteinuria PrCr ≥30 mg/mmol, ACR ≥8 mg/mmol or ≥300 mg/day or dipstick 2+ if confirmatory testing unavailable; no 'mild/severe' PE label in ongoing pregnancy; treat all HDP with antihypertensives; severe HTN ≥160/110 treat within minutes-hours monitored; targe…
· checked 2026-10-17 · verified-live
Open source ↗
100 mg twice daily with increments, divided higher dosing, 2400 mg/day limit and beta-blocker cautions.
· checked 2026-10-17 · verified-live
Open source ↗
Scanned primary PDF pages 103–104 examined by OCR and visual review: labetalol prose sequence/cumulative 300 mg, sustained-release nifedipine 10 mg twice daily/max 80 mg, and internal prose/flowchart differences for acute nifedipine and labetalol. The app exposes rather than merges the differences.
· checked 2026-10-17 · verified-live
Open source ↗
250 mg twice/three times daily, slow increments, 3 g/day maximum, hepatic/depression cautions. NICE NG133 supplies the separate postpartum stopping recommendation.
25 June 2019 · updated 17 April 2023 · checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for hdp-postpartum. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Targeted medication audit: Table…
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.