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 all women with new onset hypertension after 20 weeks of pregnancy, especially severe hypertension, require urgent specialist evaluation and likely hospital admission for ongoing monitoring of maternal and fetal wellbeing.

Specifically, arrange secondary care assessment within 24 hours by a healthcare professional trained in managing hypertensive disorders of pregnancy for all women with new onset hypertension over 140/90 mmHg after 20 weeks, and advise hospital admission if blood pressure is 160/110 mmHg or greater.

Referral is also indicated if severe hypertension is associated with symptoms or signs suggestive of pre-eclampsia or organ dysfunction, such as severe headaches, visual disturbances, epigastric pain, oliguria, or laboratory evidence of worsening renal, liver, or hematological function.

Women with severe hypertension should be offered pharmacological treatment and close monitoring, including fetal assessment with ultrasound and doppler studies, which are typically managed in secondary care.