The National Institute for Health and Care Excellence (NICE) has issued an updated quality standard focusing on diagnosis and management of hypertension and pre-eclampsia during pregnancy, labour and birth. Additionally, it provides advice for women with hypertension planning to conceive and postnatal care for women with a history of hypertension or pre-eclampsia. The updated quality standards aim to align with the recent NICE guidelines on hypertension in pregnancy.
The key goals of the quality standard are improvements in the following areas:
- Reducing premature mortality;
- Reducing mortality in babies and young children;
- Experience of maternity services for women and their families;
- Reducing the incidence of avoidable harm; and
- Safety of maternity services.
The quality standard covers the following six recommendations:
- Women of childbearing potential with treated hypertension should be provided necessary information every year regarding safe antihypertensive therapy during pregnancy.
- Pregnant women with a high risk for pre-eclampsia when the appointment was made should be offered 75-150 mg of aspirin to be taken daily from 12 weeks until birth.
- Pregnant women receiving antihypertensive drugs should have a blood pressure target of ≤135/85 mmHg.
- Pregnant women with severe hypertension should be admitted for a complete evaluation, performed by a healthcare professional with expertise in managing hypertension in pregnancy.
- Hospital admission and monitoring are recommended for pregnant women with pre-eclampsia having severe hypertension, an increased risk for adverse events or any other clinical concerns.
- A senior obstetrician should be involved in the decision-making process regarding the timing of birth for women with pre-eclampsia.
- Women who have experienced hypertension in pregnancy should receive a plan for ongoing antihypertensive management as a part of their postnatal care planning. The plan should be communicated to their general practitioner at the time of transfer to community care after birth.
- Women with a history of gestational hypertension or pre-eclampsia should discuss future pregnancy and lifetime cardiovascular risks at the time of their six- to eight-week postnatal medical review.