The pregnant woman with chronic hypertension is at risk for

• Acceleration of hypertension

• Development of superimposed preeclampsia

• Fetal growth restriction

Definition : blood pressure greater than 140/90 prior to 20 weeks of gestation

Management:

• Monitor blood pressure, urine for protein, and symptoms for worsening hypertension, or development of preeclampsia

• Treat hypertension to maintain blood pressure slightly above normal

• Follow fetal growth with serial ultrasound studies

• Fetal nonstress tests and/or biophysical profile in third trimester - time of initiation and frequency depends on control, past OB history, and fetal growth