Outcomes with masked hypertension at ⩾20 weeks (∼10%) equate

to gestational hypertension [104] and [105]. Masked hypertension could be considered (and ABPM/HBPM performed) if there are unexplained maternal or perinatal complications typically associated with GSK2118436 cell line the HDPs. 1. For women with pre-existing hypertension, the following should be performed in early pregnancy (if not previously documented): serum creatinine, fasting blood glucose, serum potassium, and urinalysis (III-D; Low/Weak) and EKG (II-2C; Low/Weak). More than 95% of these women have essential hypertension. We support the Canadian Hypertension Education Program (CHEP) work-up (see CHEP guidelines [7]). Relevant baseline testing in early pregnancy may be prudent with chronic conditions (e.g., non-alcoholic steatohepatitis) that may make subsequent interpretation of end-organ dysfunction difficult. Women at high risk for preeclampsia should be assessed for baseline proteinuria (e.g., spot PrCr) given the insensitivity of dipstick testing. Fasting blood glucose AG-014699 supplier ⩾7 mM pre-pregnancy or ⩾5.3 mM in pregnancy should prompt appropriate

investigation/referral [106] and [107]. An abnormal P wave in lead V1 by EKG may increase risk for gestational hypertension or preeclampsia [108]. Echocardiography may be useful with known/suspected left ventricular dysfunction or heart failure [7]. Routine measurement of plasma lipids is not advised. Women with suspected preeclampsia should undergo blood and urine testing (Table 3) [112], [113], [114], [115], [116], [117] and [118] designed to either: (i) detect end-organ involvement that increases the risk of adverse outcomes, (ii) detect adverse outcomes (e.g., acute renal failure), (iii) evaluate the seriousness of adverse outcome (e.g., haemoglobin with abruption), or (iv) explore important differential diagnoses. Information collected will inform timing of delivery. Most abnormalities others of maternal and fetal testing are non-specific. Interpretation relies on multiple (not single) abnormalities. With ongoing

suspicion of preeclampsia, a change in maternal or fetal status should prompt repeat testing. Abnormalities of Doppler-based assessment of the uterine or fetal circulations warrant obstetric consultation as they reflect elevated risks of adverse outcomes and results may inform timing of delivery [119], [120], [121], [122], [123], [124], [125] and [126]. Consultation may be practically limited to telephone. The BPP does not improve, and may adversely affect, high risk pregnancy outcomes [93] and [95]. Preeclampsia imitators share manifestations with preeclampsia, but require different treatments (Table 4) [127], [128], [129], [130] and [131]. A minority of women with preeclampsia will have an unclear clinical diagnosis, in which case translational biomarkers may improve diagnostic accuracy.