Delta hypertension: Sudden ⬆ in mABP – some woman will deve Eclamptic seizure or HELLP syndrome while still normoactive

BP ≥ 140/90 mmHg or

⬆ SBP 30 mmHg or DBP 15 mmHg over the pre- or early pregnancy lvl

Sustained SBP ≥ 140 mmHg or DBP ≥ 90 mmHg
(Inc in BP must measured ≥ 2 seperate occasions ≥ 6 hours or more apart)

BP returns to baseline by 12 wks postpartum ➪ Dx Transient hypertension of preg

💛HTN GA after 20 wks + No proteinuria or Absence of other findings suggest preeclampsia

Preg specific HTN with Multisystem involvement

24hr urine protein ≥ 300 mg

UPCR ≥ 0.3

Urine dipstick 1+

Thrombocytopenia (plt < 100,000/microL)

Renal insufficiency (Serum Cr ≥ 1.1 mg/dL or Doubling Serum Cr conc. in absence of other renal ds)

Impaired LFT (x2 of normal conc of Liver transaminases – AST, ALT)

Pulmonary edema

Cerebral or Visual symptoms

Mild (nonsevere): SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg AND Proteinuria ≥ 300 mg on 24hr urine collection or dipstick +1 on single sample

SBP ≥ 160 mmHg or DBP ≥ 110 mmHg

24 hr collection of Urine protein excretion ≥ 5 g

Thrombocytopenia

Hepatic dysfunction (Elevated liver transaminases or Epigastric pain)

Renal compromise (Oliguria, or Elevated serum Cr ≥ 1.1 in nonrenal ds women)

Pulmonary edema

Neurologic disturbances (Visual changes, Headache, Seizures, Coma)

Placental abruption, Fetal growth restriction, or Oligohydramnios

HELLP syndrome - variant of preeclampsia with poor prognosis
(Hemolysis, Elevated LFT, Low plt) 🍇

Often preceded by premonitory event – Severe headache & hyperreflexia

• 25% hv eclamptic seizures before labor
• 50% hv eclamptic seizures during labor
• 25% hv eclamptic seizures after delivery*

HTN present predate conception or before GA 20 wks

HTN that persists beyond 12 wks postpartum

Complications: 15% of gestational HT can deve into Chronic HT, 25% risk of deve superimposed preeclampsia or eclampsia

💛 New onset proteinuria in a woman with Chronic HT and no proteinuria prior GA 20 wks

Sudden exacerb. of HT or Need to escalate anti-HT drug dose esp when prev. well controlled with these meds

Sudden manifestations of S&S -- ⬆ abn Liver enzymes

Plt < 100,000/microliters

manifest symptoms (RUQ pain and severe headaches)

deve Pulmonary congestion or edema

deve Renal insufficiency (Serum Cr doubling or increasing ≥ 1.1 mg/dL in women w/o other renal ds)

Sudden, substantial ad sustained increases in protein excretion

Immunological factors