DSOG Guideline Bulletin: Preeclampsia and hypertension

Abstract Approximately 10% of pregnancies are complicated by hypertensive disorders of pregnancy (HDPs) in Denmark. The ‘Preeclampsia and hypertension’ guideline includes the classification, diagnosis, surveillance, and management of HDPs. This revision focuses on the diagnostic criteria for preeclampsia, preeclampsia-specific biomarkers for short-term prediction of disease, blood pressure thresholds and targets, and postpartum management. We reviewed the available literature in PubMed published since the last guideline revision in 2018, as well as the guidelines of other obstetric societies. HDPs are classified based on the timing of onset, i.e. before or after 20 weeks’ gestation, and whether proteinuria or other signs of organ dysfunction are present. We recommend against using the terms mild-moderate or severe preeclampsia in clinical practice. If possible, new-onset hypertension should be confirmed by home blood pressure monitoring. Women with HDPs should be monitored regularly, depending on diagnosis and clinical presentation. If blood pressure is ≥140 mmHg systolic and/or ≥90 mmHg diastolic, antihypertensive treatment with oral labetalol, nifedipine or methyldopa should be offered and titrated until reaching a target blood pressure of <135/85 mmHg. Magnesium sulphate treatment is recommended in eclampsia or signs of impending eclampsia. Delivery should be offered to women with preeclampsia no later than 37-38 weeks’ gestation; delivery is indicated sooner, regardless of gestational age, in preeclampsia with signs of serious, progressive disease which may include uncontrollable blood pressure, eclampsia, pulmonary oedema, progressive deterioration of biochemical parameters, or severe foetal compromise. Before operative delivery, blood pressure should be stable below 150/100 mmHg. Women with chronic or gestational hypertension should be offered planned delivery at 38-40 weeks’ gestation. Antihypertensive treatment should be continued at least one week after delivery. Lifelong yearly blood pressure monitoring is recommended to all women with HDPs.