hypertension%20in%20pregnancy
HYPERTENSION IN PREGNANCY
Hypertension in pregnancy is defined as an average diastolic blood pressure of ≥90 mmHg, based on at least 2 measurements, ≥4 hours apart or systolic blood pressure of ≥140 mmHg taken at least 6 hours apart.
Diagnosis of severe hypertension is made when blood pressure is ≥160/110 mmHg.
Measurement should be repeated after 15 minutes for confirmation.

Introduction

Categories of Hypertension in Pregnancy

Chronic Hypertension

  • Defined as blood pressure (BP) measurement of >140/90 mmHg on 2 occasions prior to pregnancy or before 20 weeks of gestation; also used to refer to hypertension that is diagnosed for the first time during pregnancy and persists beyond 12 weeks postpartum
  • Risk of developing preeclampsia is increased

Gestational Hypertension

  • Refers to women who develop hypertension without proteinuria after 20 weeks of gestation
    • May correspond to the preproteinuric phase of preeclampsia or recurrence of chronic hypertension abated in midpregnancy
  • May progress to preeclampsia
  • A diagnosis that is made retrospectively if preeclampsia is not present at the time of delivery and blood pressure returns to normal by 12 weeks postpartum

Preeclampsia/Eclampsia

  • Term used to describe condition presenting as hypertension after 20 weeks of gestation, with 1 or more of the following:
    • Proteinuria (>300 mg/24 hours) or protein to creatinine ration >0.3 mg/dL
    • Hematologic disorder: Hemolysis, thrombocytopenia, coagulopathy
    • Liver problems: Elevated liver enzymes and/or severe epigastric or right upper quadrant pain
    • Neurologic signs: Severe headache, persistent visual disturbance (scotoma), hyperreflexia with clonus, seizures (eclampsia)
    • Renal insufficiency: Oliguria or serum creatinine >1.1 mg/dL or increase to twice the normal concentration without other renal disease
    • Pulmonary edema
    • Fetal growth restriction

Definition

Preeclampsia Superimposed on Chronic Hypertension

  • Also called preexisting hypertension plus superimposed gestational hypertension with proteinuria
  • Diagnosis is based on lab tests as above and should be used to distinguish between superimposed preeclampsia and worsening chronic hypertension
  • This refers to patients having preexisting hypertension or chronic hypertension with any of the following:
    • New onset proteinuria (≥3 g/24 hours) presents at >20 weeks of gestation
    • Proteinuria in <20 weeks of gestation but with increase in proteinuria
    • Sudden increase in BP that was previously well-controlled
    • Thrombocytopenia
    • Elevated liver enzymes

Risk Factors

Preeclampsia
  • Identify high-risk patients with normal blood pressure (BP) in early gestation for close monitoring to prevent preeclampsia
    • Nulliparity
    • Extremes of maternal age (<20 years or >40 years)
    • Chronic hypertension
    • History of hypertension in previous gestation before week 34
    • History of preeclampsia/eclampsia, intrauterine growth restriction (IUGR) or unexplained stillbirth
    • Family history of preeclampsia/eclampsia
    • Preexisting medical conditions [eg diabetes mellitus (DM), collagen vascular diseases, renal vascular or parenchymal diseases]
    • Multifetal pregnancy
    • Obesity or excessive weight gain >1 kg/week
    • Autoimmune disease, eg SLE or antiphospholipid antibody syndrome
Superimposed Preeclampsia
  • Renal insufficiency
  • History of hypertension >4 years
  • Hypertension in previous pregnancy
    • An increase in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) to abnormal levels
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