Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Occurs after 20 weeks of gestation or up to 6 weeks postpartum in previously normotensive women Usually diagnosed after a rise in blood pressure of ≥ 30/15 mm Hg to a level above 140/90 mm Hg supine in the left lateral position after resting for at least 5 minutes May progress to preeclampsia when complicated by proteinuria, edema, or hematologic or hepatic abnormalities May progress to cerebral symptoms, leading to convulsions +++ GENERAL CONSIDERATIONS ++ Hypertensive disorders of pregnancy can be divided into 4 groups: – Chronic persistent hypertension, which occurs before pregnancy or before 20 weeks of gestation and persists – Gestational hypertension, which develops after 20 weeks and is not associated with preeclampsia or eclampsia – Preeclampsia or eclampsia: gestational hypertension with 1 or more of the following: proteinuria, renal insufficiency, liver involvement, neurologic (including seizure) or hematologic complication, uteroplacental dysfunction, or fetal growth restriction – White coat hypertension Is a leading cause of maternal mortality Is an endothelial disorder that results in placental ischemia Occurs more frequently in women with hypertension predating pregnancy Occurs more frequently in primigravidas, those > 45 years old, and diabetics +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Nonspecific symptoms are common, such as headache, nausea, and visual disturbances +++ PHYSICAL EXAM FINDINGS ++ Increased blood pressure Edema Hyperreflexia and clonus can occur +++ DIFFERENTIAL DIAGNOSIS ++ Chronic hypertension Unclassified hypertension when blood pressure status before conception and during first trimester is unknown +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Urinalysis: to check for protein CBC, platelets (often low) Uric acid: may be elevated Serum albumin: may be low Liver function tests: may be abnormal +++ ELECTROCARDIOGRAPHY ++ No specific abnormalities +++ IMAGING STUDIES ++ Fetal ultrasound: may show reduced size for gestational age Umbilical Doppler: may show flow abnormalities +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Cardiac complications of hypertension +++ HOSPITALIZATION CRITERIA ++ Almost all with severe preeclampsia Complications of hypertension such as heart failure +++ MEDICATIONS ++ Methyldopa is the primary treatment 250–1500 mg PO bid Nifedipine (10–20 mg PO tid) and labetalol (100–400 mg PO bid) may be used in succession for severe hypertension Hydralazine 10-mg boluses IV can be used every 20 minutes for acute elevations in blood pressure or IV labetalol 40–80 mg every 10 minutes prn to 300-mg maximum total dose Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and atenolol are contraindicated For intrapartum management, IV magnesium prevents progression of preeclampsia to seizures +++ THERAPEUTIC ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.