Hypertension in pregnancy (gestational hypertension, suspected pre-eclampsia, chronic hypertension)

• No tests in the community: refer the same day to the maternity unit (specialist obstetric centre).
• BP ≥ 160/110 mmHg, proteinuria turning positive, severe headache, visual disturbance, epigastric or right hypochondrial bar-like pain, dyspnoea.

Urine tests on a spot sample (not necessarily first morning)

• Urine protein:creatinine ratio

Laboratory tests

• FBC (platelets)
• AST
• ALT
• Serum creatinine
• LDHif neededThrombocytopenia or cytolysis: look for haemolysis, a component of HELLP syndrome (LDH > 600 IU/L, AST or ALT > 2N, platelets < 100 G/L) ^[2].
• Haptoglobinif neededThrombocytopenia or cytolysis: look for haemolysis, a component of HELLP syndrome (LDH > 600 IU/L, AST or ALT > 2N, platelets < 100 G/L) ^[2].

Then every week as long as the gestational hypertension lasts

• FBC (platelets)
• AST
• ALT
• Serum creatinine

Urine tests (dipstick every month; laboratory if ≥ 1+)

• Urine protein:creatinine ratio
• If pre-eclampsia is suspected: tests from the tab “Hypertension discovered after 20 weeks of gestation” and obstetric opinion.

Laboratory tests in early pregnancy

• FBCif needednon-French guidelineISSHP (2021) has these tests done in every woman with chronic hypertension, from diagnosis during pregnancy, as a baseline in case of later suspected superimposed pre-eclampsia (good practice) ^[7]. In early pregnancy, the French consensus provides for monitoring BP and testing for proteinuria ^[1].
• Serum creatinineif needednon-French guidelineISSHP (2021) has these tests done in every woman with chronic hypertension, from diagnosis during pregnancy, as a baseline in case of later suspected superimposed pre-eclampsia (good practice) ^[7]. In early pregnancy, the French consensus provides for monitoring BP and testing for proteinuria ^[1].
• ASTif needednon-French guidelineISSHP (2021) has these tests done in every woman with chronic hypertension, from diagnosis during pregnancy, as a baseline in case of later suspected superimposed pre-eclampsia (good practice) ^[7]. In early pregnancy, the French consensus provides for monitoring BP and testing for proteinuria ^[1].
• ALTif needednon-French guidelineISSHP (2021) has these tests done in every woman with chronic hypertension, from diagnosis during pregnancy, as a baseline in case of later suspected superimposed pre-eclampsia (good practice) ^[7]. In early pregnancy, the French consensus provides for monitoring BP and testing for proteinuria ^[1].

48 to 72 hours after delivery (pre-eclampsia; often done at the maternity unit)

• FBC (platelets)
• AST
• ALT
• Serum creatinine

Visit 6 to 8 weeks after delivery

• Urine protein:creatinine ratio (or dipstick in the practice)
• Serum creatinine with GFR
• Fasting plasma glucoseif neededAssessment and management of other cardiovascular and renal risk factors, recommended after any hypertension of pregnancy ^[1].
• Lipid profile (fasting)if neededAssessment and management of other cardiovascular and renal risk factors, recommended after any hypertension of pregnancy ^[1].

At 3 months if proteinuria persists (≥ 1+)

• Serum creatinine with GFR
• Urine albumin:creatinine ratio

Every year for the first 5 years

• Fasting plasma glucoseif needednon-French guidelineAfter hypertension of pregnancy, the risk of diabetes and hypercholesterolaemia increases: the Netherlands considers these tests every year for 5 years, then every 3 years ^[11], ISSHP does them at 1 year ^[7] and SOMANZ considers them every year for 5 to 10 years ^[4] (expert opinion, no supporting trial). The French consensus asks to assess these risk factors without setting dates ^[1].
• Lipid profileif needednon-French guidelineAfter hypertension of pregnancy, the risk of diabetes and hypercholesterolaemia increases: the Netherlands considers these tests every year for 5 years, then every 3 years ^[11], ISSHP does them at 1 year ^[7] and SOMANZ considers them every year for 5 to 10 years ^[4] (expert opinion, no supporting trial). The French consensus asks to assess these risk factors without setting dates ^[1].
• Serum creatinineif needednon-French guidelineAfter hypertension of pregnancy, the risk of diabetes and hypercholesterolaemia increases: the Netherlands considers these tests every year for 5 years, then every 3 years ^[11], ISSHP does them at 1 year ^[7] and SOMANZ considers them every year for 5 to 10 years ^[4] (expert opinion, no supporting trial). The French consensus asks to assess these risk factors without setting dates ^[1].
• Urine albumin:creatinine ratioif needednon-French guidelineAfter hypertension of pregnancy, the risk of diabetes and hypercholesterolaemia increases: the Netherlands considers these tests every year for 5 years, then every 3 years ^[11], ISSHP does them at 1 year ^[7] and SOMANZ considers them every year for 5 to 10 years ^[4] (expert opinion, no supporting trial). The French consensus asks to assess these risk factors without setting dates ^[1].