Practice

Guidelines

Management of hypertensive disorders during pregnancy: summary of NICE guidance

BMJ 2010; 341 doi: 10.1136/bmj.c2207 (Published 25 August 2010)
Cite this as: BMJ 2010;341:c2207

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  1. Cristina Visintin, project manager1,
  2. Moira A Mugglestone, director of guideline development 1,
  3. Muhammad Q Almerie, foundation house officer 12,
  4. Leo M Nherera, health economist1,
  5. David James, clinical codirector1,
  6. Stephen Walkinshaw, consultant in maternal and fetal medicine3
  7. on behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Women’s and Children’s Health, London W1T 2QA
  2. 2North Yorkshire and East Coast Foundation School, Diana, Princess of Wales Hospital, Grimsby DN33 2BA
  3. 3Liverpool Women’s Hospital, Liverpool L8 7SS
  1. Correspondence to: M A Mugglestone mmugglestone{at}ncc-wch.org.uk

    Why read this summary?

    Hypertensive disorders of pregnancy cover a spectrum of conditions, including chronic (pre-existing) hypertension, pre-eclampsia, and gestational hypertension (box 1). These conditions are associated with increased perinatal mortality and morbidity. Hypertensive disorders cause one in 50 stillbirths in normal babies and 10% of all preterm births. They contribute to a third of cases of severe maternal morbidity.1 Pre-eclampsia is one of the most common causes of maternal death in the United Kingdom.2 This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on how to manage hypertensive disorders during pregnancy.3

    Box 1 Definitions

    • Chronic hypertension: hypertension present at booking visit or before 20 weeks’ gestation, or being treated at time of referral to maternity services; can be primary or secondary in aetiology

    • Clinically relevant proteinuria: more than 300 mg protein in a 24 hour urine collection or more than 30 mg/mmol in a spot urinary protein:creatinine sample

    • HELLP syndrome: haemolysis, elevated liver enzymes, and low platelet count

    • Gestational hypertension: new hypertension presenting after 20 weeks’ gestation without clinically relevant proteinuria

    • Mild hypertension: diastolic blood pressure 90-99 mm Hg, systolic blood pressure 140-149 mm Hg

    • Moderate hypertension: diastolic blood pressure 100-109 mm Hg, systolic blood pressure 150-159 mm Hg

    • Pre-eclampsia: new hypertension presenting after 20 weeks’ gestation with clinically relevant proteinuria

    • Severe hypertension: diastolic blood pressure 110 mm Hg or greater, systolic blood pressure 160 mm Hg or greater

    • Severe pre-eclampsia: pre-eclampsia with severe hypertension or with symptoms, biochemical abnormalities, or haematological impairment (or any combination thereof)

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in …

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