Women with gestational hypertension (without pre-eclampsia)

For women with gestational hypertension at less than 36+6 weeks’ gestation, expectant management is advised, while those with ges­tational hypertension at 37+0 weeks or more of gestation, initiating delivery within days should be discussed (101, 102).

Women with pre-existing hypertension

For women with pre-existing hypertension at less than 36⁺6 weeks’ gestation, expectant management is advised, even if women re­quire treatment with antihypertensive therapy. On balance from the existing evidence, but in the absence of trial data that are ur­gently required, for women with uncomplicated pre-existing hyper­tension who are otherwise well at 37⁺0 weeks or more of gestation, initiating delivery should be considered at some time between 38+0 and 39+6weeks’ gestation (104).

Mode of delivery

For women with any HDP, vaginal delivery should be considered unless a caesarean delivery is required for the usual obstetric

indications (14, 15). If vaginal delivery is planned and the cervix is unfavourable, then cervical ripening should be used to increase the chance of a successful vaginal delivery. At a gestational age remote from term, women with a HDP with evidence of fetal compromise may benefit from delivery by emergent caesarean delivery.

Antihypertensive treatment should be continued throughout la­bour and delivery to maintain SBP at less than 160 mmHg and DBP at less than 110 mmHg (14, 15). The third stage of labour should be ac­tively managed with oxytocin 5 units intravenously or 10 units intra­muscularly, particularly in the presence of either thrombocytopenia or coagulopathy (14, 15). However, ergometrine maleate should not be administered to women with any HDP, particularly pre-eclampsia or gestational hypertension; alternative oxytocics should be considered. and MgSO4 will limit their use in the woman with pre-eclampsia. Adequate analgesia and ongoing monitoring are important compo­nents of overall postpartum management.

Arterial line insertion may be used for continuous arterial BP monitoring when BP control is difficult or there is severe bleeding. In addition, an arterial line is useful when repetitive blood sampling is required, for example, in women with HELLP syndrome (14, 15). Central venous pressure monitoring is not routinely recom­mended and, if a central venous catheter is inserted, it should be used to monitor trends and not absolute values (14, 15). Similarly, pulmonary artery catheterization is not recommended unless there is a specific associated indication and then only in an intensive care setting (14, 15).