Hypertensive disorders are common during pregnancy and can be classified into four pregnancy-associated categories: (1) chronic hypertension, (2) gestational hypertension, (3) preeclampsia, and (4) chronic hypertension with superimposed preeclampsia. In addition, non-pregnancy associated hypertensive emergencies can occur in the pregnant patient.
Acute Hypertensive Definitions in the Pregnant Patient
| Name | BP Criteria | Additional Criteria |
| “Severe” acute hypertension |
SBP ≥ 160 mm Hg or DBP ≥ 110 mm Hg | |
| Preeclampsia | SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg | BP readings must occur on ≥ 2 occasions, ≥ 4 hr apart, > 20 weeks gestation Either: • Proteinuria (24 hr urine collection ≥ 300 mg protein OR spot urine collection Uprotein/UCr ≥ 0.3 mg/dL) • Severe featuresa |
| Eclampsia | Preeclampsia degree of BP elevation | New-onset grand mal seizures in a woman with no known seizure disorder |
| HELLP syndrome | With or without preeclampsia degree of BP elevation | Evidence of the following: • Hemolysis (schistocytes on peripheral smear, increased LDH, decreased haptoglobin, increased Tbili [≥ 1.2 mg/dL], decreased haematocrit) • Elevated liver enzymes AST/ALT (≥ 70 IU/L) • Low Platelet (< 100,000 mcL) |
| Hypertensive emergency |
BP ≥ 240/140 mm Hg |
aSevere features = SBP ≥ 160 mm Hg or DBP ≥ 110 mm Hg, Plt < 100,000/mm3, AST/ALT > 2 x ULN, right upper quadrant or epigastric pain unresponsive to medication, cerebral/visual symptoms, renal injury (SCr > 1.1 mg/dL or > 2 x baseline), or pulmonary edema.
Abbreviations: Tbili = total bilirubin; UCr = urinary creatinine; ULN = upper limit of normal; Uprotein = urinary protein; SBP = systolic blood pressure; DBP = diastolic blood pressure.
References:
- Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Med. 2019 Apr 10;7:2050312119843700. [Medline]
- Wilkerson RG, Ogunbodede AC. Hypertensive Disorders of Pregnancy. Emerg Med Clin North Am. 2019 May;37(2):301-316. [Medline]
Created Nov 21, 2019.
