II. Definitions
- Gestational Hypertension
- Hypertension in Pregnancy with onset beyond 20 weeks gestation and NO Proteinuria
- Preeclampsia will develop in 50% of those with Gestational Hypertension
- Postpartum Hypertension
- Hypertension onset after delivery
III. Precautions
- Preeclampsia will develop in 50% of those with Gestational Hypertension onset 24-35 weeks
- Severe Gestational Hypertension is associated with worse outcomes than mild PIH
- Treat with same management protocol as Severe Preeclampsia
- Buchbinder (2002) Am J Obstet Gynecol 186:66-71 [PubMed]
IV. Labs
- Initial
- Complete Blood Count with Platelet Count
- Serum Electrolytes including Serum Potassium
- Serum Creatinine and Blood Urea Nitrogen
- Lactate Dehydrogenase (LDH, obtain as initial baseline, and if HELLP develops)
- Serum transaminases (AST, ALT)
- Spot Urine Protein to Creatinine Ratio (or 24 Hour Urine Protein)
- Later
- Repeat initial labs weekly (other than LDH)
V. Monitoring
- Initial evaluation (at time of diagnosis)
- Estimate Fetal Growth
- Estimate amniotic fluid index (AFI) weekly
- Non-Stress Test (NST) 1-2 times weekly
- Biophysical Profile (BPP) if NST not reactive
- Further evaluation if BPP <8
- Repeat Testing
- Ultrasound every 4 weeks starting at 28 weeks gestation (assess Fetal Growth)
- Other testing as indicated for significant maternal status changes
VI. Management: Gestational Hypertension
- Clinic visits at least weekly
- Monitor for development of Preeclampsia (and esp. Severe Preeclampsia)
- Blood Pressure Monitoring
- PIH Symptom assessment
- Repeat labs (CBC, BMP/chem, AST, ALT, Urine Protein to Creatinine Ratio)
-
Gestational Hypertension with Severe Features (treated as Severe Preeclampsia)
- Gestational Hypertension AND
- End organ injury OR severe range Hypertension (SBP>160 or DBP>110 mmHg on two readings)
- See Severe Preeclampsia for end organ injury criteria
-
Hypertension Management with Medications
- See PIH Blood Pressure Management
- Indicated only for Gestational Hypertension with Severe Features (>160/110 mmHg)
- Contrast with chronic Hypertension in which medications are started when >140/90 mmHg
- Delivery timing
- Recommended at 37 weeks (or at time of diagnosis)
VII. Management: Postpartum Hypertension
- Obtain labs as above (if not already performed)
- Monitor for Preeclampsia With Severe Features
-
Hypertension Management with Medications
- Treat confirmed elevated Blood Pressures >150/100 mmHg
VIII. Complications: Pregnancy Related
- Superimposed Preeclampsia (50% for Gestational Hypertension)