Chronic hypertension

 BP > 140/90 before pregnancy, less than 20 weeks gestation, or more than 12
weeks postpartum

Gestational hypertension
 Hypertension without proteinuria/other preeclamptic features more than 20
weeks gestation for at least 4 h

Preeclampsia
 Pathophysiology – vasospasm and endothelial damage  leaky vessels  local
hypoxemia of tissue  necrosis, hemolysis, end organ damage
o Vasospasm  increased SVR (HTN), decreased intravascular volume,
decreased oncotic pressure  susceptible to pulm edema and sensitive
to fluid shifts (fluid overload with IV fluids and hypotension with blood
loss)
 Cured only by termination of pregnancy and almost always resolves after delivery
 Risk factors: nulliparity, extremes of age, African American race, history of
severe rpreE, chronic HTN, chronic renal disease, obsesity, APA syndrome,
diabetes, multifetal gestation
 Hypertension (>140 systolic or >90 diastolic) measured twice six h apart with
new onset proteinuria (>300 mg/24 h, urine prot:creat > 0.3), usually >20 wks
 If not proteinuria, thrombocytopenia, impaired LFTs, renal insufficiency, pulm
edema, cerebral disturbances, or visual impairment

Preeclampsia with severe features

 Vasospasm with preeclampsia with threatened end organ damage
 Necessitates delivery
 Severe features
o Systolic BP > 160 or diastolic BP > 110 on two occasions 4 h apart
o Platelets < 100000
o Impaired LFTs or severe persistent epigastric/RUQ pain
o Progressive renal insufficiency (Cr > 1.1)
o Pulm edema
o New onset cerebral or visual disturbance

Superimposed preeclampsia
 Development of preeclampsia with chronic HTN
o Increased BP and/or new onset proteinuria;

Superimposed preeclampsia with severe features

 Preeclampsia in patient with chronic HTN w/ severe HTN despite max therapy,
cerebral/visual symptoms, pulmonary edema, low platelets, elevated LFTs, or
new onset renal insufficiency (Cr > 1.1)

HELLP
 Hemolysis, elevated LFTs, low platelets
 Significant fetal/maternal morbidity

Eclampsia
 Seizure + preeclampsia
Treatment
 Gestional HTN and preE w/o severe features – observed and delivered at term
(37 wks), MgS use individualized
 Chronic HTN well controlled and uncomplicated – observe and deliver at 38-39
wks
 Unstable pt  delivery
 Avoid NSAIDs in postpartum preE pts  may elevate BP
 Acute management of severe HTN (160 sys or 110 diast >15 min)
o Therapy initiated quickly to avoid stroke
o First line trt incl IV labetalol, IV hydralazine, oral nifedipine