Hypertension in pregnancy: the NICE guidelines

Hypertension in pregnancy may indicate a chronic medical problem, gestational hypertension (new hypertension without proteinuria) or pre-eclampsia (new hypertension with new proteinuria). Chronic hypertension can mimic gestational hypertension and strongly predisposes to superimposed pre-eclampsia. Gestational hypertension is often benign but may also be an early stage in the development of pre-eclampsia. Pre-eclampsia is not benign. Previously the first cause of maternal death in the UK, it is now the second.1 Maternal deaths from pre-eclampsia have not fallen recently and, most disturbingly, are asso-ciated with the highest rates of substandard care, of all causes of maternal deaths.1 It is also the most important reason for iatrogenic prematurity, a major contributor to perinatal mortality and a substantial cause of fetal growth restriction, especially with preterm disease.2 Pre-eclampsia cannot be reliably prevented or reversed once it is established except by delivery, which removes the causednamely, the placenta. Nevertheless, the past 30 years have seen considerable advances in its management. For both mother and baby the outlook is better than it was, at least in the developed world. The new NICE guidelines for the management of hypertension in pregnancy (available on line a