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Hypertensive Disorders Complicating Pregnancy



Hypertension in pregnancy is defined as systolic BP ≥ 140 mm of Hg or diastolic BP ≥90 mm of Hg on two occasions at least 6 hours but no more than 7 days apart.



Pregnancy induced hypertension

Chronic hypertension in pregnancy


(Means-a normotensive patient has conceived and due to some placental pathology, her B/P increases)

Literally means a hypertensive female has conceived

• Rise in B/P seen before 20 weeks

• No proteinuria

• B/P does not come back to normal within 12 weeks of delivery.



A. Preeclampsia

1. Rise in B/P seen after 20 weeks of pregnancy.

2. Proteinuria (>300 mg in 24 hr urine collection or >30 mg/dl in a random urine sample or ≥ + 1 on dipstick.)

3. B/P comes back to normal within 12 weeks of delivery


B. Gestational Hypertension

• Like Preeclampsia but no proteinuria is associated

Increased certainty of preeclampsia

  1. BP ≥ 160/100 mmHg
  2. Proteinuria 2.0 g per 24 h or ≥ 2 + dipstick
  3. Serum creatinine> 1.2 mg/ dL unless known to be previously elevated
  4. Platelets <100,000/mm3
  5. Microangiopathic hemolysis (increased LDH)
  6. Elevated SGOT or SGPT
  7. Persistent headache or other cerebral or visual disturbances
  8. Persistent epigastric pain.


Seizures that cannot be attributed to other causes in a woman with preeclampsia.


Superimposed preeclampsia (on chronic hypertension)


New-onset proteinuria >300 mg per 24 h in hypertensive women but no proteinuria before 20 weeks of gestation


A sudden increase in proteinuria or blood pressure or platelet count <100,000/mm3 in women with hypertension and proteinuria before 20 weeks of gestation.

  1. Hypertension is diagnosed when the resting blood pressure is 140/90 mmHg or greater; Korotkoff phase V is used to define diastolic pressure. In the past, it had been recommended that an incremental increase of 30 mmHg systolic or 15 mmHg diastolic pressure be used as diagnostic criteria, even when absolute values were below 140/90 mmHg. These criteria are no longer recommended because evidence shows that these women are not likely to suffer increased adverse pregnancy outcomes.
  2. Edema has been abandoned as a diagnostic criterion because it occurs in too many normal pregnant women.

Risk Factors for Preeclampsia

  1. Patient younger than 20 or older than 35 years of age
  2. Young primigravida (exposed to chorionic villi for the first time)
  3. Placental abnormalities: Vesicular mole, multiple pregnancy (exposed to a superabundance of chorionic villi)
  4. Maternal obesity, preexisting DM, and preexisting hypertension/renal disease
  5. Past history / family history of preeclampsia
  6. Thrombophilias, Autoimmune disease (APLA syndrome),
  7. Fetal hydrops
  8. Smoking is protective for preeclampsia (Smoking is also protective for fibroids and endometriosis)
  9. Placenta previa has also been reported to reduce the risk of hypertensive disorders in pregnancy.



According to Sibai, currently plausible potential causes include the following:

  1. Abnormal trophoblastic invasion of uterine vessels
  2. Immunological intolerance between maternal and fetoplacental tissues (decrease in Th1 and increase in Th2 helper T cells)
  3. Maternal maladaptation to cardiovascular or inflammatory changes of normal pregnancy (imbalance between vasoconstrictors and vasodilators, increase in TXA2, endothelin-1, and increase sensitivity to angiotensin II, whereas prostacyclin and NO decreases)
  4. Dietary deficiencies
  5. Genetic influences (HLA-DR4)
  6. Abnormal trophoblastic invasion: In normal implantation, the uterine spiral arteries undergo extensive remodeling as they are invaded by endovascular trophoblasts. In preeclampsia, however, there is incomplete trophoblastic invasion. In preeclampsia only the decidual vessels, but not myometrial vessels, become lined with endovascular trophoblasts.

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