Hypertensive Disorders of Pregnancy

Chronic Hypertension:

 • Guidelines as SBP ≥130 or DBP ≥ 90 mmHg

 • Suggest two measurements at least 4 hours apart unless severe HTN

 • Diagnosed before 20 weeks gestation or...

 • First diagnosed during pregnancy and persists > 12 weeks postpartum

Gestational Hypertension:

 • After 20 weeks gestation, SBP ≥ 140 or DBP ≥ 90

 • Suggest two measurements at least 4 hours apart unless severe HTN

 • No proteinuria or features of severe preeclampsia

Preeclampsia:

 • After 20 weeks gestation: SBP ≥ 140 or DBP ≥ 90 on two occasions 4 hrs apart or SBP ≥ 160 or DBP ≥ 110 mmHg once And Proteinuria (e.g., 300 mg/24 hr urine, UPCR ratio ≥ 0.3, or Urine Dipstick ≥2+) OR

 • If no proteinuria, evidence of organ injury: thrombocytopenia (pits <100k), ↑ liver enzymes (2x ULN) or severe RUQ pain, renal insufficiency (Cr > 1.1 mg/dL or doubling of Cr), pulmonary edema, cerebral or visual disturbances

Preeclampsia+:

 • Preeclampsia Severe Features: SBP ≥ 160 or DBP ≥ 110 mmHg twice 4 hours apart on bedrest (before Anti-HTN meds) or any finding of organ injury

 • Eclampsia: Tonic-clonic seizure (typically) in preeclampsia patients

 • HELLP: Syndrome of hemolysis, elevated liver enzymes, Low platelets associated with preeclampsia or eclampsia

Chronic HTN + Preeclampsia:

 • In patients with chronic HTN → sudden ↑ BP that was under control or rapid ↑ in anti HTN meds

 • New onset proteinuria or sudden ↑ proteinuria in a patient with h/o proteinuria

 • Often not an exact diagnosis so have high clinical suspicion!



- Karan Desai MD @karanpdesai via CardioNerds @cardionerds



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