Patient handout

Gestational Hypertension (without severe features)

PRODUCTION

1. Your condition

This handout is for gestational hypertension (without severe features). Your care team identified this based on: new bp ≥140/90 after 20 weeks (no prior chronic htn).

Other reasons your team may use this plan: bp ≥160/110 in pregnancy (route urgently — severe htn); prior pre-eclampsia or gestational htn — high-risk surveillance; risk profile triggers aspirin prophylaxis (chronic htn, t1/t2dm, ckd, autoimmune, multiples).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	81 mg	PO	once daily	USPSTF 2021 + ACOG 2020 (PB 222) — preeclampsia prevention from 12 wk through 36 wk

Plan: Gestational HTN — severity-tiered (non-severe PO maintenance; severe acute IV)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Stable — BP <140/90 at home, no symptoms, normal kick counts

If you have:

Home BP <140/90 — CHAP (Tita NEJM 2022)
No severe-feature symptoms — ACOG 2020 (PB 222)
Normal fetal kick counts (≥10 in 2 h) — ACOG 2020 (PB 222)

Do this:

Continue PO antihypertensive as prescribed — CHAP (Tita NEJM 2022)
Continue aspirin 81 mg daily through 36 weeks if started — USPSTF 2021
Home BP twice daily; log values — CHAP (Tita NEJM 2022)
Daily kick counts — ACOG 2020 (PB 222)
Attend all scheduled prenatal visits + NSTs — ACOG 2020 (PB 222)

YELLOW — Caution — BP 140–159 / 90–109, mild symptoms, or any new concern

If you have:

Home BP 140–159/90–109 sustained — ACOG 2020 (PB 222)
Mild headache responding to acetaminophen — ACOG 2020 (PB 222)
Reduced (but not absent) fetal movement — ACOG 2020 (PB 222)
Mild swelling progression — ACOG 2020 (PB 222)

Do this:

Recheck BP in 15 min after rest — ACOG 2020 (PB 222)
Take any prescribed PRN dose if instructed — ACOG 2020 (PB 222)
Drink water + lie left-side — ACOG 2020 (PB 222)
Call OB office same day — ACOG 2020 (PB 222)
Increase home BP checks to QID — CHAP (Tita NEJM 2022)

Call your provider if:

BP remains ≥140/90 on repeat after 15 min — ACOG 2020 (PB 222)
Symptoms persist >2 h — ACOG 2020 (PB 222)
Reduced fetal movement persists after a snack and 1 h focused counting — ACOG 2020 (PB 222)

RED — Medical alert — go to L&D / ED now

If you have:

BP ≥160/110 on home cuff (any single reading) or two readings ≥150/100 in 15 min — ACOG 767 (2017)
Severe headache not relieved by acetaminophen — ACOG 2020 (PB 222)
Visual changes (scotomata, blurred vision, photopsia) — ACOG 2020 (PB 222)
Persistent right-upper-quadrant or epigastric pain — ACOG 2020 (PB 222)
Sudden swelling of face/hands — ACOG 2020 (PB 222)
Decreased fetal movement (<10 kicks in 2 h after focused counting) — ACOG 2020 (PB 222)
Vaginal bleeding, leaking fluid, contractions — ACOG 2020 (PB 222)
Seizure or loss of consciousness — ACOG 2020 (PB 222)

Do this:

Go to L&D / ED immediately — do not wait — ACOG 2020 (PB 222)
Call 911 if seizing or unable to travel safely — ACOG 2020 (PB 222)
Bring medication list and home BP log — ACOG 2020 (PB 222)

Call your provider if:

Any red-zone trigger — proceed to L&D, do not call first — ACOG 2020 (PB 222)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

BP ≥160/110 sustained × 15 min in patient with gestational HTN — ACOG 767 (2017)
New proteinuria (UPCR ≥0.3 OR 24-h ≥300 mg) developing in known gestational HTN — ACOG 2020 (PB 222)
New severe feature (severe HA, vision changes, RUQ pain, plt <100K, AST/ALT ≥2× ULN, Cr ≥1.1 or doubling, pulmonary edema) — ACOG 2020 (PB 222)
Decreased fetal movement, non-reassuring NST, or FGR <10th percentile in known GHTN — ACOG 2020 (PB 222)
New severe HTN ≥160/110 up to 6 weeks postpartum after GHTN diagnosis — AHA 2021; ACOG 2020 (PB 222)
BP sustained ≥160/110 × 15 min in known gestational HTN antepartum or intrapartum → immediate antihypertensive load + admit for severe-feature workup (CBC, LFT, Cr, LDH, UPCR, fetal monitoring) — ACOG 767 (2019); ACOG 222 (reaff 2024)
Any single severe feature emerges in known gestational HTN — ANY of: sustained SBP ≥160 / DBP ≥110, AST/ALT ≥2× ULN, plt <100×10⁹/L, creatinine ≥1.1 mg/dL OR doubling from baseline, persistent severe headache, visual changes (scotomata, blurred vision, photopsia), pulmonary edema, persistent severe epigastric / RUQ pain — ACOG 222 (2020, reaff 2024); ISSHP 2024
Severe features confirmed OR eclamptic seizure occurs → magnesium 4-6 g IV load over 15-20 min + 1-2 g/h infusion × 24 h after delivery OR 24 h after last seizure — ACOG 222 (2020, reaff 2024); Magpie Trial Lancet 2002 (PMID 12057549)
Estimated fetal weight (EFW) <10th percentile + abdominal circumference (AC) <10th percentile + abnormal umbilical artery Doppler (absent or reversed end-diastolic flow) in known gestational HTN → MFM consult + close growth surveillance + delivery timing per ACOG / SMFM consensus
BP ≥160/110 within 6 weeks postpartum in patient with GHTN history → ED for assessment + IV antihypertensive + consider magnesium prophylaxis; routes to cardio.htn.core.v1 for long-term management if BP fails to normalise by 12 wk — AHA 2021; ACOG 767 (2019); ACOG 222 (reaff 2024)
Chronic HTN diagnosed pre-pregnancy OR in first 20 wks gestation → start antihypertensive at sustained ≥140/90 per CHAP NEJM 2022 (PMID 35452981) — distinct from GHTN diagnostic criterion (BP ≥140/90 AFTER 20 wk in previously normotensive woman)

5. Follow-up

Postpartum BP at 3–7 d, 1–2 wk, 4–6 wk (HTN often persists 6–12 wk); aspirin from 12 wk in next pregnancy; lifelong CV risk follow-up (GHTN doubles future CV risk per AHA 2021)

6. Sources

Guideline: ACOG Practice Bulletin 222 (2020, reaffirmed 2024) + ACOG Committee Opinion 767 (severe HTN, 2019) + ACOG 203 (chronic HTN, CHAP) + CHAP (Tita NEJM 2022) + CHIPS (Magee NEJM 2015) + ISSHP 2024 (Mol et al; supersedes ISSHP 2021) + USPSTF 2021 (aspirin) + ASPRE 2017 + HYPITAT-II Lancet 2015 + PARROT Lancet 2019 + PROGNOSIS NEJM 2016 + Magpie Trial Lancet 2002 + NICE NG133 (2023) + AHA 2021 postpartum HTN scientific statement