Hypertensive Disorders in Pregnancy
Description Referral DESCRIPTION Hypertension in pregnancy, pre-eclampsia and eclampsia may have very serious and fatal consequences for both the mother and the baby. Hypertension is defined by: A systolic BP ≥ 140 and/or a diastolic BP ≥ 90 mmHg measured on 2 occasions, 4 hours apart. OR A systolic BP ≥ 160 and/or a diastolic BP ≥ 110 mmHg measured on a single occasion. (Always measure BP in the
DESCRIPTION
Hypertension in pregnancy, pre-eclampsia and eclampsia may have very serious and fatal consequences for both the mother and the baby.
Hypertension is defined by:
- A systolic BP ≥ 140 and/or a diastolic BP ≥ 90 mmHg measured on 2 occasions, 4 hours apart.
OR
- A systolic BP ≥ 160 and/or a diastolic BP ≥ 110 mmHg measured on a single occasion. (Always measure BP in the left lateral or sitting position (and not supine position)).
Hypertensive disorders of pregnancy can be classified as:
- Chronic hypertension:
- Hypertension diagnosed before pregnancy or < 20 weeks of pregnancy.
- Gestational hypertension:
- Hypertension without proteinuria, with onset ≥ 20 weeks of pregnancy.
- Pre-eclampsia:
- Hypertension with proteinuria, with onset ≥ 20 weeks of pregnancy (high risk patients include: nulliparity, obesity, multiple pregnancy, chronic hypertension, kidney disease, diabetes, pre-eclampsia in a previous pregnancy, advanced maternal age or adolescent pregnancy).
- Eclampsia:
- Generalised tonic-clonic seizures in women with pre-eclampsia.
- Chronic kidney disease:
- Proteinuria with/without hypertension, diagnosed at < 20 weeks of pregnancy.
Categorising hypertensive disease:
- A diastolic BP of 90-109 mmHg and/or systolic BP of 140-159 mmHg; but with NO symptoms or organ dysfunction is classified as hypertensive disease without severe features.
- Maternal features of severe hypertensive disease are any or more of the following:
- Acute severe hypertension (diastolic BP of 110 mmHg and/or systolic >160 mmHg).
- Thrombocytopenia (platelet count <100 000/μL).
- Impaired liver function (ALT or AST >40 IU/L).
- Severe persistent right upper quadrant or epigastric pain.
- HELLP syndrome (platelets <100 000 and AST >70 μl and LDH >600 μl).
- Serum creatinine ≥120 micromol/L.
- Pulmonary oedema.
- New-onset severe headache unresponsive to medication.
- Visual disturbances.
REFERRAL
Urgent
- Hypertension with severe features (refer to high risk labour ward urgently)
- Pre-eclampsia with or without severe features (refer to high risk labour ward, urgently if severe features present)
Non-urgent
- Chronic hypertension
- Chronic kidney disease
See: Chronic hypertension
See: Gestational hypertension: No severe features
See: Gestational hypertension: With severe features
See: Pre-eclampsia
See: Eclampsia
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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026
Chapter 6: Obstetrics and Gynaecology_6.4.2 Hypertensive Disorders in Pregnancy