Ambulatory BP or home BP monitoring should be considered to exclude white-coat and masked hypertension, which are common in pregnancy.Guideline rec
Class IIaLevel CRec Table 13 · §12.3 · p.4521
Hypertension and pre-eclampsia
Inputs
Risk factors for pre-eclampsia (Table 15) [TBL]
Output
Aspirin is printed for at least one high-risk factor or two moderate-risk factors (Table 15). None ticked.
Home BP monitoring may be considered as an adjunct to office BP measurements in pregnant women to detect new-onset hypertension or for monitoring BP control.Guideline rec
Class IIbLevel BRec Table 13 · §12.3 · p.4521
- Gestational hypertension accompanied by one or more of the following new-onset conditions at or after 20 weeks gestation:
- Proteinuria [urinary albumin excretion in a 24 h urine sample >0.3 g/day or UACR in a random spot urine sample >30 mg/mmol (0.3 mg/mg)]
- Other maternal organ dysfunction including:
- Acute kidney injury (serum creatinine ≥90 μmol/L; 1 mg/dL)
- Liver dysfunction (elevated ALT or AST >40 IU/L; >0.67 μkat/L with or without right upper quadrant or epigastric abdominal pain)
- Neurological complications (e.g. eclampsia/convulsions, altered mental status, blindness, stroke, clonus, severe headaches, persistent visual scotomata)
- Haematological complications (platelet count <150 000/μL, disseminated intravascular coagulation, haemolysis)
- Uteroplacental dysfunction (IUGR, abnormal umbilical artery Doppler waveform analysis, or stillbirth).
Table 14, printed p4516
- Proteinuria threshold: Figure 12B prints albumin/creatinine ratio ≥8 mg/mmol or protein/creatinine ratio ≥30 mg/mmol. Table 14 prints urinary albumin excretion >0.3 g/day or UACR >30 mg/mmol (0.3 mg/mg). The checklist uses the figure's pair and shows Table 14 beside it; a reviewing physician must confirm which applies.
- Biomarker thresholds: Figure 12B prints 'sFlt-1/PIGF ≥85 or PIGF <12 pg/mL' as positive. The text (§12.3.2.2) prints sFlt-1/PlGF <38 as able to reliably exclude pre-eclampsia over the next 7 days. Nothing between 38 and 85 is interpreted.
- Nifedipine dose (Figure 12C footnote d): Printed as 'Nifedipine 5–10 mg p.o. 10 mg p.o. if >160/110 mmHg.' The footnote is garbled; it is shown as printed and flagged [REVIEW].
- Nitroglycerine dose: The text prints 5 μg/min, increasing every 3–5 min to a maximum of 100 μg/min, in combination with diuretics. Figure 12C prints no dose. Flagged [REVIEW].
- Delivery timing, pre-eclampsia with severe features: Rec Table 13 prints 37 weeks for pre-eclampsia without severe features and 'expedite delivery' for pre-eclampsia with adverse markers; the text prints 'early delivery' for severe features. No gestational age is printed for severe features.
- Severe-range threshold wording: Rec Table 13 prints 'Systolic BP ≥160 mmHg or diastolic BP ≥110 mmHg'; the text of §12.3.3 prints 'BP >160/110 mmHg' for admission and Figure 12A prints '≥160/≥110'. The figure and Rec Table 13 (≥) are used.
Educational summary of the 2025 ESC Guidelines. It does not replace clinical judgement or local protocol.