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 #Hypertensive #Disorders #Pregnancy #hypertension #htn #obstetrics #cardiology #differential #diagnosis
