Hans van den Heuvel

1 Hypertension known before pregnancy or present in the first 20 weeks Chronic hypertension hypertension predating the pregnancy or <20 weeks’ gestation White-coat hypertension elevated office/clinic (≥140/90 mmHg) blood pressure, but normal when measured at home or work (<135/85 mmHg); it is not an entirely benign condition and conveys an increased risk for preeclampsia. Masked hypertension characterized by BP that is normal at a clinic or office visit but elevated at other times, most typically diagnosed by 24-hour ambulatory BP monitoring (ABPM) or automated home BP monitoring. Hypertension arising de novo at or after 20 weeks Gestational hypertension new onset of hypertension (BP ≥140 mmHg systolic or ≥90 mmHg diastolic) at or after 20 weeks’ gestation in the absence of features of preeclampsia. Preeclampsia De novo; or Superimposed on chronic hypertension Gestational hypertension accompanied by ≥1 of the following new- onset conditions at or after 20 weeks’ gestation: - Proteinuria - Other maternal organ dysfunction, including: o Acute kidney injury (creatinine ≥90umol/L) o Liver involvement (elevated transaminases) with or without right upper quadrant or epigastric abdominal pain o Neurological complications (examples: eclampsia, stroke, clonus, severe headaches, and persistent visual scotomata) o Hematological complications (thrombocytopenia, dissemi- nated intravascular coagulation, hemolysis) o Uteroplacental dysfunction (such as fetal growth restriction, abnormal umbilical artery Doppler wave form analysis, or stillbirth) Table 1. Classification of hypertensive disorders of pregnancy. (BP: blood pressure) Adapted from the International Society for the Study of Hypertension in Pregnancy (ISSHP) 5 For most of these women at risk of complications in pregnancy, care can be provided in the outpatient department. However, from the point complications are diagnosed, hospital admission is recommended for close antenatal surveillance. During this admission, maternal and fetal symptoms and signs can be followed on a daily basis. Results from an inventory by the Dutch Healthcare Authority (NZa), Dutch Society for Obstetrics and Gynaecology (NVOG) and Perined (The Dutch Perinatal Registry) estimate that yearly, around 20.000 women are admitted in pregnancy for antenatal complications. This accounts for 12% of pregnancies in the Netherlands and these numbers are similar in other high-income countries. 6-8 Hospitalisation during pregnancy is considered an event of significant impact, because of combined stressors of the admission and (complicated) pregnancy. 9-11 It has a negative impact on well-being of both women and fetus. Symptoms of increased psychological stress, lack of activity, feelings of uncertainty and separation of home and family account for dissatisfaction of the in-hospital stay amongst women. INTRODUCTION 9