Differentials

Gestational Hypertension BP > 140/90 for the first time during pregnancy (mid-pregnancy/ after 20 weeks) No proteinuria BP returns to normal < 12 weeks post- partum Nonspecific term and provisional diagnosis

Gestational Hypertension Rule in Elevated BP, received at OBAS 170/100 Rule out Patient has proteinuria of 3+ dipstick

Pre-Eclampsia BP > 140/90 after 20 weeks in a patient with previously normal BP proteinuria: –Urinary excretion > 300 mg protein / 24 hr urine specimen or > 1+ dipstick

Indication of Severity AbnormalityMILDSEVERE Diastolic BP< 100 mm Hg110 mm Hg or higher ProteinuriaTrace to 1+Persistent 2+ or more Headache(-)(+) Visual disturbances(-)(+) Upper abdominal pain(-)(+) Oliguria(-)(+) Convulsion(-)Present (eclampsia) Serum creatininenormalElevated Thrombocytopenia(-)(+) Liver enzyme elevationMinimalMarked Fetal growth restriction(-)Obvious Pulmonary edema(-)(+)

Chronic Hypertension BP > 140/90 mm Hg before pregnancy or before 20 weeks gestation OR Hypertension first diagnosed after 20 weeks AND persistent after 12 weeks postpartum

Chronic Hypertension Rule in Elevated BP Rule out Patient still to be monitored if with elevated BP in the 12 weeks postpartum

Chronic Hypertension with Superimposed Pre-eclampsia New-onset proteinuria > 300mg/24hrs in hypertensive women but NO proteinuria before 20 weeks AOG Sudden increase in proteinuria or BP or platelet count < 100,000 cells/mm3 in patients WITH hypertension and proteinuria before 20 weeks gestation

Chronic Hypertension with Superimposed Pre-eclampsia Rule in Patient fulfilled the minimum criteria of pre-eclampsia Rule out Patient has no known history of elevated BP before pregnancy

Eclampsia Seizures that cannot be attributed to other causes in a woman with pre-eclampsia

Eclampsia Rule in Patient fulfills the minimum criteria of pre-eclampsia Rule out No seizure episode occurred

Algorithm Pregnant with BP > 140/90 < 20 weeks AOG No/stable proteinuria Chronic hypertension New / inc proteinuria/ dev’t of  BP/ HELLP Chronic HPN with superimposed pre-eclampsia > 20 weeks AOG proteinuria positive Pre-eclampsia negative Gestational Hypertension