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 MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. 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 Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth