II. Definitions

  1. Gestational Hypertension
    1. Hypertension in Pregnancy with onset beyond 20 weeks gestation and NO Proteinuria
    2. Preeclampsia will develop in 50% of those with Gestational Hypertension
  2. Postpartum Hypertension
    1. Hypertension onset after delivery

III. Precautions

  1. Preeclampsia will develop in 50% of those with Gestational Hypertension onset 24-35 weeks
    1. Barton (2001) Am J Obstet Gynecol 184(5): 979-83 [PubMed]
  2. Severe Gestational Hypertension is associated with worse outcomes than mild PIH
    1. Treat with same management protocol as Severe Preeclampsia
    2. Buchbinder (2002) Am J Obstet Gynecol 186:66-71 [PubMed]

IV. Labs

  1. Initial
    1. Complete Blood Count with Platelet Count
    2. Serum Electrolytes including Serum Potassium
    3. Serum Creatinine and Blood Urea Nitrogen
    4. Lactate Dehydrogenase (LDH, obtain as initial baseline, and if HELLP develops)
    5. Serum transaminases (AST, ALT)
    6. Spot Urine Protein to Creatinine Ratio (or 24 Hour Urine Protein)
  2. Later
    1. Repeat initial labs weekly (other than LDH)

V. Monitoring

  1. Initial evaluation (at time of diagnosis)
    1. Estimate Fetal Growth
    2. Estimate amniotic fluid index (AFI) weekly
    3. Non-Stress Test (NST) 1-2 times weekly
    4. Biophysical Profile (BPP) if NST not reactive
    5. Further evaluation if BPP <8
  2. Repeat Testing
    1. Ultrasound every 4 weeks starting at 28 weeks gestation (assess Fetal Growth)
    2. Other testing as indicated for significant maternal status changes

VI. Management: Gestational Hypertension

  1. Clinic visits at least weekly
    1. Monitor for development of Preeclampsia (and esp. Severe Preeclampsia)
    2. Blood Pressure Monitoring
    3. PIH Symptom assessment
    4. Repeat labs (CBC, BMP/chem, AST, ALT, Urine Protein to Creatinine Ratio)
  2. Gestational Hypertension with Severe Features (treated as Severe Preeclampsia)
    1. Gestational Hypertension AND
    2. End organ injury OR severe range Hypertension (SBP>160 or DBP>110 mmHg on two readings)
      1. See Severe Preeclampsia for end organ injury criteria
  3. Hypertension Management with Medications
    1. See PIH Blood Pressure Management
    2. Indicated only for Gestational Hypertension with Severe Features (>160/110 mmHg)
    3. Contrast with chronic Hypertension in which medications are started when >140/90 mmHg
  4. Delivery timing
    1. Recommended at 37 weeks (or at time of diagnosis)

VII. Management: Postpartum Hypertension

  1. Obtain labs as above (if not already performed)
  2. Monitor for Preeclampsia With Severe Features
  3. Hypertension Management with Medications
    1. Treat confirmed elevated Blood Pressures >150/100 mmHg

VIII. Complications: Pregnancy Related

  1. Superimposed Preeclampsia (50% for Gestational Hypertension)

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Related Studies

Ontology: Unspecified postpartum hypertension (C0156690)

Concepts Disease or Syndrome (T047)
ICD9 642.94
English Unspecified postpartum hypertension, Hypertens NOS-postpartum, Unspecified hypertension complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication, Unspecified Postpartum Hypertension
Dutch niet-gespecificeerde hypertensie postpartum
French Hypertension non précisée, postpartum
German unspezifische postpartale Hypertonie
Italian Ipertensione non specificata postpartum
Portuguese Hipertensão pós-parto NE
Spanish Hipertensión postparto no especificada
Japanese 詳細不明の分娩後高血圧, ショウサイフメイノブンベンゴコウケツアツ
Czech Blíže neurčená poporodní hypertenze
Hungarian Meghatározatlan postpartum hypertonia

Ontology: Hypertension induced by pregnancy (C0340274)

Definition (NCI) A blood pressure elevation after 20 weeks of gestation in the absence of either proteinuria or systemic findings like thrombocytopenia, impaired liver function, progressive renal insufficiency, pulmonary edema or the new-onset of cerebral or visual disturbances.(NICHD)
Definition (MSH) A condition in pregnant women with elevated systolic (>140 mm Hg) and diastolic (>90 mm Hg) blood pressure on at least two occasions 6 h apart. HYPERTENSION complicates 8-10% of all pregnancies, generally after 20 weeks of gestation. Gestational hypertension can be divided into several broad categories according to the complexity and associated symptoms, such as EDEMA; PROTEINURIA; SEIZURES; abnormalities in BLOOD COAGULATION and liver functions.
Concepts Pathologic Function (T046)
MSH D046110
ICD10 O13
SnomedCT 156106005, 156112000, 198969004, 267307002, 267306006, 308551004, 48194001, 30354006
LNC LA19981-2
English H/T - pregnancy, Hypertension induced by pregnancy, HYPERTENSION, PREGNANCY-INDUCED, HYPERTENSION PREGN IND, Hypertension of pregnancy NOS, pregnancy-induced hypertension, pregnancy-induced hypertension (diagnosis), PIH - Preg-ind hypertension, Induced Hypertension, Pregnancy, Pregnancy Induced Hypertension, Induced Hypertensions, Pregnancy, Hypertensions, Pregnancy Induced, gestational hypertension NOS, Hypertension, Pregnancy-Induced [Disease/Finding], PIH Pregnancy induced hypertension, Pregnancy induced hypertension, high blood pressure disorder caused by pregnancy, high blood pressure caused by pregnancy, hypertension in pregnancy, pregnancy induced hypertension, gestational hypertension, Hypertension of pregnancy, Hypertension induced by pregnancy (disorder), Hypertension of preg., Hypertension of pregnancy NOS (disorder), Pregnancy-Induced Hypertension, Hypertension gestational, Gestational hypertension, GH - Gestational hypertension, PIH - Pregnancy-induced hypertension, Gestational hypertension (disorder), Pregnancy-induced hypertension (disorder), Pregnancy-induced hypertension, pregnancy; hypertension, Pregnancy-induced hypertension, NOS, Gestational Hypertension, Hypertension, Gestational, Hypertension, Pregnancy Induced, Hypertension, Pregnancy-Induced, Pregnancy Associated Hypertension
Swedish Graviditetshypertoni
Czech hypertenze indukovaná těhotenstvím, Těhotenstvím indukovaná hypertenze, Gestační hypertenze
Spanish Hipertensión Inducida en el Embarazo, Hipertensión inducida por el embarazo, Hipertensión gestacional, hipertensión durante el embarazo, SAI, hipertensión durante el embarazo, SAI (trastorno), Hypertension of pregnancy NOS, Hipertensión Gestacional, hipertensión gestacional (trastorno), hipertensión gestacional, hipertensión gestacional [dup] (trastorno), hipertensión inducida por el embarazo, hipertensión inducida por el embarazo (trastorno)
Finnish Raskauteen liittyvä kohonnut verenpaine
Russian GIPERTENZIIA, VYZVANNAIA BEREMENNOST'IU, ГИПЕРТЕНЗИЯ, ВЫЗВАННАЯ БЕРЕМЕННОСТЬЮ
Japanese 妊娠中毒症, 妊娠中毒, 妊娠高血圧, 妊娠誘発性高血圧, 高血圧-妊娠誘発性, 高血圧症合併妊娠, 妊娠性高血圧, 高血圧症-妊娠, 妊娠高血圧症, ニンシンコウケツアツ, ニンシンコウケツアツショウコウグン, 妊娠高血圧症候群, 高血圧-妊娠性
Dutch zwangerschapsgeinduceerde verhoogde bloeddruk, zwangerschapshypertensie, zwangerschap; hypertensie, Hypertensie, zwangerschaps-, Zwangerschapshypertensie
Portuguese Hipertensão gestacional, Hipertensão induzida pela gravidez, Hipertensão arterial induzida pela gravidez, Hipertensão Gestacional, Hipertensão Induzida por Gravidez, Hipertensão Induzida pela Gravidez
Italian Ipertensione gestazionale, Ipertensione gravidica (PIH), Ipertensione da gravidanza, Ipertensione gravidica
German Bluthochdruck in der Schwangerschaft, schwangerschaftsbedingte Hypertonie, PIH schwangerschaftsbedingte Hypertonie, Gestationshypertonie, Hypertonie, schwangerschaftsinduzierte, Schwangerschaftsinduzierte Hypertonie
French Gestational hypertension, Hypertension gestationnelle (HG), Hypertension artérielle gravidique, Hypertension gestationnelle, Hypertension liée à la grossesse, Hypertension induite par la grossesse, Hypertension de la grossesse
Polish Nadciśnienie wywołane ciążą, Nadciśnienie ciążowe
Croatian HIPERTENZIJA UZROKOVANA TRUDNOĆOM, GESTACIJSKA HIPERTENZIJA
Hungarian Terhesség által kiváltott hypertonia, Gestationalis hypertonia, PIH terhesség által kiváltott hypertonia
Norwegian Svangerskapshypertoni, Graviditetsblodtrykk, Graviditetshypertoni