Differentials

Gestational Hypertension

• BP > 140/90 for the first time during pregnancy (mid-pregnancy/ after 20 weeks)

• No proteinuria

• BP returns to normal < 12 weeks post-partum

• Nonspecific term and provisional diagnosis

Gestational Hypertension

Rule in• Elevated BP ,

received at OBAS 170/100

Rule out• Patient has

proteinuria of 3+ dipstick

Pre-Eclampsia• BP > 140/90 after 20 weeks in a patient

with previously normal BP

• proteinuria:– Urinary excretion > 300 mg protein / 24 hr

urine specimen or > 1+ dipstick

Indication of SeverityAbnormality MILD SEVERE

Diastolic BP < 100 mm Hg 110 mm Hg or higher

Proteinuria Trace to 1+ Persistent 2+ or more

Headache (-) (+)

Visual disturbances (-) (+)

Upper abdominal pain (-) (+)

Oliguria (-) (+)

Convulsion (-) Present (eclampsia)

Serum creatinine normal Elevated

Thrombocytopenia (-) (+)

Liver enzyme elevation Minimal Marked

Fetal growth restriction (-) Obvious

Pulmonary edema (-) (+)

Chronic Hypertension

• BP > 140/90 mm Hg before pregnancy or before 20 weeks gestation

OR

• Hypertension first diagnosed after 20 weeks AND persistent after 12 weeks postpartum

Chronic Hypertension

Rule in• Elevated BP

Rule out• Patient still to be

monitored if with elevated BP in the 12 weeks postpartum

Chronic Hypertension with Superimposed

Pre-eclampsia• New-onset proteinuria > 300mg/24hrs in hypertensive women but NO proteinuria before 20 weeks AOG

• Sudden increase in proteinuria or BP or platelet count < 100,000 cells/mm3 in patients WITH hypertension and proteinuria before 20 weeks gestation

Chronic Hypertension with Superimposed Pre-eclampsia

Rule in• Patient fulfilled the

minimum criteria of pre-eclampsia

Rule out• Patient has no known

history of elevated BP before pregnancy

Eclampsia• Seizures that cannot be attributed to other

causes in a woman with pre-eclampsia

Eclampsia

Rule in• Patient fulfills the

minimum criteria of pre-eclampsia

Rule out• No seizure episode

occurred

AlgorithmPregnant with BP > 140/90

< 20 weeks AOG > 20 weeks AOG

proteinuriaNo/stable

proteinuria

New / inc proteinuria/ dev’t of BP/

HELLP

Chronic hypertensionChronic HPN with

superimposed pre-eclampsia

positive

negative

Pre-eclampsia

Gestational Hypertension