Table 3.

Basic laboratory tests recommended for monitoring patients with hypertension in pregnancy

Hemoglobulin and hematocrit	Hemoconcentration supports diagnosis of gestational hypertension with or without proteinuria. It indicates severity. Levels may be low in very severe cases because of hemolysis
Platelet count	Low levels < 100,000 × 109/L may suggest consumption in the microvasculature. Levels correspond to severity and are predictive of recovery rate in post-partum period, especially for women with HELLP syndrome*
Serum AST, ALT	Elevated levels suggest hepatic involvement. Increasing levels suggest worsening severity
Serum LDH	Elevated levels are associated with hemolysis and hepatic involvement. May reflect severity and may predict potential for post partum recovery, especially for women with HELLP syndrome
Proteinuria (24-h urine collection)	Standard to quantify proteinuria. If exceeding 2 g/day, very close monitoring is warranted. If an excess of 3 g/day, delivery should be considered
Urinalysis	Dipstick test for proteinuria has significant false-positive and false-negative rates. If dipstick results are positive (≥ 1), a further investigation is needed, including albumin/creatinine ratio. Negative dipstick results do not rule out proteinuria, especially if DBP ≥ 90 mmHg
Albumin to creatinine ratio (ACR)	Can be quickly determined in a single spot urine sample. A value < 30 mg/mmol reliably rules out proteinuria. A value of ≥ 30 mg/ mmol should possibly be followed by a 24 hour urine collection
Serum uric acid	Elevated levels aid in differential diagnosis of gestational hypertension and may reflect severity
Serum creatinine	Levels drop in pregnancy. Elevated levels suggest increasing severity of hypertension; assessment of 24-h creatinine clearance may be necessary

*HELLP hemolysis, elevated liver enzyme levels and low platelet count