Hypertensive disorders in pregnancy
Advanced, Clinical Subspecialties
Chronic Hypertension : Hypertension diagnosed prior to conception due to systolic values greater than 140 mmHg and/or diastolic values greater than 90 mmHg OR hypertension that does not resolve in the postpartum period.
Gestational hypertension : Onset of hypertension (Systolic BP >139 mmHg and/or diastolic > 89 mmHg) after 20 weeks post-conception without the presences of proteinuria AND resolves within 12 weeks postpartum. Considered chronic hypertension if it does not resolve in the postpartum period.
Pre-eclampsia : new onset hypertension and proteinuria after 20 weeks gestation. See diagnostic criteria below from ACOG:
Diagnostic Criteria for Preeclampsia
• A systolic blood pressure (SBP) greater than or equal to 140 mmHg or a diastolic blood pressure (DBP) greater than or equal to 90 mmHg or higher on two occasions at least 4 hours apart after 20 weeks gestation in a woman with a previously normal blood pressure
• A SBP greater than or equal to 160mm Hg or a DBP greater than or equal to 110 mmHg or higher, hypertension can be confirmed within minutes to facilitate timely antihypertensive therapy
• Greater than or equal to 300 mg/24 hours urine collection (or this amount extrapolate from a timed collection)
• Protein/creatinine ration greater than or equal to 0.3
• Dipstick reading of 1+ (used only if other quantitative methods are not available)
Or, in the absence of proteinuria, new-onset hypertension with the new onset of any of the following:
• Thrombocytopenia (platelet count less than 100,000/uL)
• Renal insufficiency (serum creatinine greater than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease)
• Impaired liver function (elevated liver transaminases to twice normal concentration)
• Pulmonary edema
• Cerebral or visual symptoms
It is also further classified into pre-eclampsia without severe features and pre-eclampsia with severe features. Pre-eclampsia with severe features is diagnosed by the presence of one of the following: 1) BP 160/110 mmHg, 2) Thrombocytopenia (< 100,000mm3), 3) Serum creatinine > 1.1 mg/dL or >2 times the baseline, 4) Pulmonary edema, 5) New-onset cerebral or visual disturbances, or 6) Impaired liver function
Eclampsia : New onset of seizures in woman with pre-eclampsia
HELLP : Onset of hemolysis, elevated liver enzymes, and low platelet count in woman with pre-eclampsia. .