When should I consider referring a pregnant patient with severe hypertension to a specialist?

Consider referring a pregnant patient with severe hypertension (blood pressure ≥160/110 mmHg) to a specialist immediately for secondary care assessment. This is because severe hypertension in pregnancy requires hospital admission for ongoing monitoring of both maternal condition and fetal wellbeing. Referral should be arranged within 24 hours by a healthcare professional trained in managing hypertensive disorders of pregnancy. Women with severe hypertension are likely to need initiation or adjustment of antihypertensive therapy and detailed fetal monitoring including ultrasound and cardiotocography. Additionally, if there are signs or symptoms suggestive of pre-eclampsia or organ dysfunction, urgent specialist input is essential.

Specifically, referral is indicated for:

• New onset hypertension after 20 weeks gestation with blood pressure ≥160/110 mmHg.
• Severe pre-eclampsia with hypertension not responding to treatment or associated with severe headaches, visual disturbances, epigastric pain, oliguria, or worsening laboratory parameters.
• Any suspicion of pre-eclampsia based on symptoms or proteinuria.

Early specialist involvement ensures appropriate maternal and fetal monitoring, timely initiation of antihypertensive treatment (e.g., labetalol, nifedipine), and planning for delivery if indicated.

Therefore, refer pregnant women with severe hypertension urgently to secondary care for specialist assessment and management.

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