FFinalistSouthampton · 2027
Obstetrics & gynaecology
AKT · Obstetrics & gynaecology/Antenatal & medical

Hypertension in pregnancy (incl. pre-eclampsia)

Placental-origin hypertensive disorder

Overview

Spans gestational hypertension (new BP ≥140/90 after 20 weeks, no proteinuria), pre-eclampsia (hypertension + proteinuria/organ involvement after 20 weeks) and eclampsia (seizures). A leading cause of maternal/fetal morbidity.

Recognise

  • Pre-eclampsia: hypertension + proteinuria after 20 weeks ± headache, visual disturbance, epigastric/RUQ pain, brisk reflexes, oedema
  • HELLP: Haemolysis, Elevated Liver enzymes, Low Platelets
  • Eclampsia: tonic-clonic seizures

Red flags

  • BP ≥160/110, severe headache/visual symptoms, epigastric pain, clonus, HELLP, eclamptic seizure → emergency

Differentials & how to tell them apart

Chronic (pre-existing) hypertensionpresent before 20 weeks
Gestational hypertensionhypertension WITHOUT proteinuria/organ involvement
Other causes of seizuresepilepsy, but eclampsia until proven otherwise in pregnancy

Investigations

BP and urine protein (PCR/ACR) at every visit; bloods (FBC for platelets, LFTs, U&E, urate); fetal assessment (growth USS, CTG); placental growth factor (PlGF) testing.

Management

Labetalol (first-line) + magnesium sulfate for seizure prophylaxis/treatment

  1. 1Aspirin 75–150 mg daily from 12 weeks in at-risk women (prevention). Treat BP with labetalol first-line (nifedipine/methyldopa alternatives).Gate: BP ≥160/110 → admit; give magnesium sulfate to prevent/treat eclamptic seizures in severe pre-eclampsia/eclampsia
  2. 2Definitive treatment is DELIVERY of the placenta — timed by gestation and severity; continue magnesium 24h postpartum.
Labetalol — first-line antihypertensive (oral or IV)
Nifedipine / methyldopa — alternatives (avoid ACEi/ARB — teratogenic)
Magnesium sulfate — prevents/treats eclamptic seizures
Aspirin 75–150 mg — from 12 weeks for prevention in at-risk women

Key points

Magnesium sulfate is the drug for eclampsia (monitor for toxicity — loss of reflexes, respiratory depression; antidote calcium gluconate). ACE inhibitors/ARBs are contraindicated. Delivery is the cure.

Monitor & prognosis

BP, proteinuria, bloods (platelets/LFTs), fetal growth/CTG; magnesium toxicity (reflexes, RR, urine output).

Resolves after delivery; recurrence risk in future pregnancies.

Source: NICE NG133; CKS Hypertension in pregnancy