Monitoring
After initial assessment and stabilisation, monitoring intervals are dictated by the severity of the condition. Blood pressure should be monitored regularly for rising levels, the need for intervention, and the response to therapy; however, there is little guidance on how often this should be. A good guide is at least 4 times per day on a ward, or continuously in an intensive care unit.[16] Measure full blood count, liver function tests, and renal function at least twice weekly (or three times a week, if severity dictates).[16] There is no strong evidence linking the level of proteinuria with adverse outcome; therefore, once a diagnosis has been made, there is no benefit in repeating urinalysis unless new symptoms and signs develop.[16]
Fetal cardiotocography should be performed at diagnosis and then only if clinically indicated: for example, if there is vaginal bleeding, reduced fetal movements, or increased severity of disease, in which case it should be performed daily, or continuously if delivery is planned.[16] Umbilical artery Doppler velocimetry and fetal ultrasound are recommended every 2 weeks.[16]
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After delivery, continued maternal monitoring is required until the condition has improved.[16] This can be done as an outpatient if the condition allows. Antihypertensive treatment should be reviewed after 2 weeks. If the condition has not completely improved by 6 weeks, the diagnosis should be reconsidered and a referral to the appropriate specialist is warranted.
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