Management of a new pregnancy in a woman with chronic hypertension
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1497 (Published 06 June 2016) Cite this as: BMJ 2016;353:i1497
- Pippa Oakeshott, professor of general practice1,
- Lucy C Chappell, NIHR research professor in obstetrics2
- 1Population Health Research Institute, St George’s, University of London, London SW17 0RE, UK
- 2Women’s Health Academic Centre, King’s College London, London, UK
- Correspondence to: P Oakeshott oakeshot{at}sgul.ac.uk
- Accepted 24 February 2016
What you need to know
At first presentation of a newly pregnant woman with chronic hypertension, arrange prompt referral to an obstetrician, preferably one specialising in hypertension
Such women have an increased risk of pre-eclampsia, preterm delivery, small for gestational age infant, or stillbirth
Ensure that you assess the safety of her antihypertensive drugs in pregnancy and change them that day if necessary—for example, stop angiotensin converting enzyme inhibitors
A 28 year old woman attends surgery saying that she is six weeks pregnant with her second baby and would like to be referred to the midwives. She says that she had a problem with high blood pressure in her previous pregnancy three years ago and has been taking nifedipine and ramipril since then, as she continued to have high blood pressure when she tried to stop taking her tablets. She wonders if she should now stop these tablets and whether they are safe for her baby.
What you should cover
Ask about
Current pregnancy—Date of last menstrual period to estimate her current gestation (and expected date of delivery); some antihypertensive drugs need to be stopped once a positive pregnancy test has been confirmed (box 1).
Previous pregnancy—Admissions for high blood pressure, gestation, indication for delivery, and health problems for her or the baby to indicate likelihood of recurrence. She is at increased risk if problems occurred at an earlier gestation.
Previous investigations for high blood pressure—Has she seen a specialist or had renal ultrasonography, electrocardiography, echocardiography, or other tests …
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