Hypertension in Pregnancy, Preeclampsia, and Eclampsia

To begin with, there are roughly 3 things - chronic hypertension, non-proteinuric (gestational) hypertension, and preeclampsia (and eclampsia).

What is the difference between these? The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP)

  • Which is the gold standard for recording blood pressure in pregnancy? Mercury Sphygmomanometer, Aneroid sphygmomanometer, Digital Automated Sphygmomanometer, Omron T9P, or Omron MIT Elite (HEM-7300-WE)?
  • Pre-eclampsia and gestational hypertension are characterised by the new onset of hypertension (>140 mmHg systolic or >90 mmHg diastolic) after 20 weeks gestation. A lady presents at 18 weeks of gestation with 120/80 mmHg and in 22nd week she presents with 140/90 mmHg. Are pre-eclampsia and gestational hypertension the only differentials for her?
  • The above lady, how should she be managed if there is no way to know about blood pressures before 16 weeks?
  • De-novo hypertension after 20 weeks can be gestational or preeclampsia. It is preeclampsia if any of the following are present. Fill in the blanks.
    1. Proteinuria (spot urine protein/creatinine >30 mg/mmol [0.3 mg/mg] or >300 mg/day or at least 1 g/L[‘2 + ’] on dipstick testing
    2. Other maternal organ dysfunction:
    • renal insufficiency (………. >90 umol/L; 1.02 mg/dL)
    • ….. involvement (elevated …………. – at least twice upper limit of normal ± right upper quadrant or epigastric abdominal pain)
    • neurological complications (examples include eclampsia, altered mental status, blindness, stroke, or more commonly hyperreflexia when accompanied by clonus, severe headaches when accompanied by hyperreflexia, persistent visual scotomata)
    • haematological complications (…….cytopenia – …….. count below 150,000/dL, DIC, haemolysis)
    1. Uteroplacental dysfunction
    • …… growth restriction
  • With point 3 above in mind, what will you do if a lady has 150/100 mmHg blood pressure but no dipstick proteinuria?
  • What is HELLP? Why does it come on this page?
  • What is gestational proteinuria? Can it be called pre-preeclampsia? Yes, why? But no, why?
  • If white coat hypertension is confirmed in 24h ambulatory BP monitoring, can the pregnancy be considered as safe as a normal pregnancy?
  • When the BP is above 160/110 mmHg it is agreed that it should be lowered to below 160/110 mmHg over a few hours to prevent stroke, etc. What BP level will you maintain during non-urgent situations for a hypertensive?
  • When do you deliver a woman with preeclampsia?

You can also see some definitions in this Management of hypertensive disorders during pregnancy: summary of NICE guidance (paywall after the definitions)

Also read WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia (2011)

  • WHO recommends the use of calcium(1.5-2 g/day), aspirin (75mg), antihypertensives, magnesium sulphate, and induction of labor. When, in what cases?
  • WHO not recommends bed rest, salt intake restriction, vitamin D, C, E supplementation, diuretics (thiazides), and corticosteroids. When, in what cases?

Before going to the etiopathology, make sure you read about placenta

Read this article from Journal of OBG, India 2014 titled Preeclampisa - eclampsia