Hypertensive Disorders in Pregnancy
Hypertensive disorders are among the most common and serious complications of pregnancy. Proper classification is essential for guiding management and surveillance.
Classification Hierarchy
- Chronic Hypertension: HTN predating pregnancy or diagnosed before 20 weeks of gestation.
- Gestational Hypertension: New-onset HTN (≥ 140/90 mmHg) after 20 weeks of gestation without proteinuria or organ dysfunction.
- Pre-eclampsia: New-onset HTN after 20 weeks plus proteinuria OR evidence of maternal organ dysfunction (e.g., thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral/visual disturbances).
- Pre-eclampsia with Severe Features: Pre-eclampsia with BP ≥ 160/110 mmHg, severe symptoms, or end-organ damage.
- Eclampsia: The development of seizures in a patient with pre-eclampsia, not attributable to other neurological conditions.
Management Pillars
| Therapy | Indication/Purpose |
|---|---|
| Magnesium Sulfate | First-line for seizure prophylaxis in pre-eclampsia with severe features and treatment of eclampsia. |
| Antihypertensives | Labetalol, Nifedipine (oral), or Hydralazine (IV) for acute BP control (≥ 160/110 mmHg). |
High-Yield Exam Pearl:
- HELLP Syndrome: A severe variant of pre-eclampsia characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets.
- Prevention: Low-dose aspirin (81–150 mg) is recommended for high-risk patients starting at 12–16 weeks to prevent pre-eclampsia.