From the Research
Antepartum surveillance for patients with hypertension should be tailored to the severity of the condition, with more frequent monitoring for those with higher risk, starting at 33 weeks gestation for uncomplicated patients and as early as 26 weeks gestation for those with complications such as intrauterine growth restriction, preeclampsia, diabetes, systemic lupus erythematosis, or chronic renal disease. For chronic hypertension without severe features, surveillance typically includes blood pressure monitoring at each prenatal visit, with more comprehensive assessment every 3-4 weeks starting at 24-28 weeks gestation, as recommended by studies such as 1. This should include:
- Fetal growth ultrasounds
- Amniotic fluid assessment
- Non-stress tests or biophysical profiles For gestational hypertension or preeclampsia without severe features, twice-weekly surveillance is recommended, including non-stress tests, blood pressure monitoring, and assessment for symptoms of preeclampsia, as suggested by 1. For severe preeclampsia or hypertension with severe features, daily or inpatient monitoring may be necessary, with continuous fetal heart rate monitoring and frequent maternal evaluation, as indicated by 2 and 3. Laboratory tests including complete blood count, liver function tests, creatinine, and urine protein should be performed weekly for preeclampsia patients, as recommended by 4. More frequent surveillance is warranted with additional risk factors such as intrauterine growth restriction, diabetes, or abnormal umbilical artery Doppler studies, as suggested by 1 and 4. This intensive monitoring helps detect early signs of placental insufficiency or fetal compromise, allowing for timely intervention to optimize maternal and fetal outcomes. The most recent and highest quality study, 1, provides guidance on the frequency of antepartum surveillance in patients with hypertension, and its recommendations should be prioritized in clinical practice.