What monitoring protocols should be followed for pregnant patients diagnosed with hypertension to ensure maternal and fetal safety?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For pregnant patients diagnosed with hypertension, **fetal monitoring** should include ultrasound assessments of fetal growth, amniotic fluid volume, and umbilical artery doppler velocimetry at diagnosis and regularly every 2 to 4 weeks if normal, with more frequent monitoring if indicated by clinical findings .

In women with pre-eclampsia or severe gestational hypertension, **cardiotocography (CTG)** should be performed at diagnosis and only repeated if clinically indicated .

Women with pre-eclampsia or severe hypertension should also undergo **ultrasound for fetal growth and amniotic fluid assessment, and umbilical artery doppler velocimetry at diagnosis and every 2 weeks if normal, with subsequent surveillance based on findings** .

**Blood pressure** should be measured hourly during labour in women with hypertension, and every 15 to 30 minutes until blood pressure is less than 160/110 mmHg in women with severe hypertension .

**Maternal blood tests** such as platelet count, transaminases, and serum creatinine should be monitored 48 to 72 hours after birth or step-down from critical care if women had pre-eclampsia, with repeat testing as needed until results normalize .

Women should be advised to seek immediate medical review if they develop symptoms of pre-eclampsia, such as severe headaches, visual disturbances, or epigastric pain, and should have urine protein quantified if dipstick is positive .

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