Admission, delivery and monitoring in severe hypertensive disorders of pregnancy
THE CONTEXT
Women with gestational hypertension or pre-eclampsia with severe features require admission; management depends on gestation and maternal and fetal stability.
Admission and delivery
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Women with gestational hypertension or pre-eclampsia with severe features should be admitted.
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At or beyond 34 weeks, delivery is recommended after maternal stabilization and steroid administration.
Expectant management and surveillance
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For women with stable maternal and fetal conditions, expectant management may be an option in a tertiary care setting.
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Maternal monitoring includes a complete blood count with platelets, liver enzymes and serum creatinine. Clinical assessment and laboratory testing are performed serially.
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Fetal surveillance includes nonstress tests, twice-weekly biophysical profiles, ultrasound assessment of fetal growth and umbilical artery Doppler studies.