Organ | Pathology | Assessment | Considerations in pregnancy |
---|---|---|---|
Heart | Left ventricular hypertrophy/remodelling Impaired cardiac function Ischaemic heart disease | Clinical examination ECG Echo | 30–50% increase in cardiac output required for pregnancy Cardiac disease is commonest cause of maternal death in UK |
Kidneys | Albuminuria Proteinuria Hypertensive nephropathy Chronic kidney disease | uACR/uPCR Serum creatinine | uACR >8 mg/mmol, uPCR >30 mg/mmol and serum creatinine >77 μmol/L are abnormal in pregnancy6 CKD confers risk of adverse pregnancy outcome and loss of maternal kidney function |
Retina and brain | Hypertensive retinopathy Hypertensive/ischaemic optic neuropathy | Fundoscopy | Consider hypertensive crisis, warrants inpatient assessment/management Needs exclusion of secondary hypertension |
Arteries | Increased peripheral arterial stiffness Atherosclerosis | Consider vascular risk in pregnancy Serum cholesterol increases in pregnancy and is not routinely checked or treated |
CKD = chronic kidney disease; ECG = electrocardiography; Echo = echocardiography; uACR = urinary albumin:creatinine ratio, uPCR = urinary protein:creatinine ratio.